The Global Burden of TB

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Tuberculosis An Opportunity to Reach Zero Deaths in ourLifetime

Dr Lucica Ditiu, Executive Secretary, Stop TB Partnership27 th October 2014, Barcelona

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Which disease is

responsible for the mostdeaths in the last 200 years

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theachievem

ents

peopletreated for TB since 199556 million

Reduction in TB mortalitySince 199045%

Lives savedSince 199522 million

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403632

282420141210

target global10 / 100k / 100k

TB incidence in the European Region

theburden

2013 2018 2023 2028

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The Missing Cases

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TB Incidence Rates (per 100,000 popn)

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What is MDR-TB?

A form of TB that is resistant to at least twokey anti-TB medicines

Difficult (terrible side effects) to treat Expensive to treat 150X more than "normal"

TB (drugs only) Man made Clear sign of under investment and poor TB

care

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theburden Why is MDR a public health crisis?

0

100

200

300

400

500

600

700

Est. number of ALL MDRTB cases in the World

today

Est. number of NEW MDRTB cases per year

New cases diagnosed New cases on treatment

T h o u s a n

d s

17,000 patients onwaiting list for treatment

Less than 25% of estimatednew MDR cases were

detected in 2012

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theburden

27 high MDR-TB burden countries in 2012

WHO 2013 Global Tuberculosis Report;

15% in Africa (4)

55% in Europe (15)

30% in Asia (8)

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continuous transmission

Airborneeveryone issusceptible

unless we endthe epidemic

2 billion peopleinfected with TB

0%200 million

will develop TB

1 TB caseinfects up to15 / year

WHO 2012 Global Tuberculosis Report; CDC 2013; Styblo 1985; Basu 2009

1 MDR caseinfects up to10 / year

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thelessonslearned

lives saveddue to TB & HIV

integration(2005-2011)

25 fold increasecases detected & treated

due to prioritized

interventions invulnerable populations

doubleddetection & treatmentthrough engagement

with TB communities

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thepotential

of newtools minutes to diagnoseRif resistant TB with Gene Xpert

machine90

new vaccinecandidates inthe pipeline12

months to treat TBwith new drugs and regimens indevelopment (compared withcurrent 6-24 months)

4

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What is the Stop TB Partnership?

Vision A TB-free world. Zero deaths, disease and suffering due to tuberculosis

Mission Ensure that every TB patient has access to effective

diagnosis, treatment and cure Reduce the inequitable social and economic toll of TB Develop and implement new preventive, diagnostic and

therapeutic tools and strategies to stop TB

Targets By 2015: the global burden of TB disease (deaths and

prevalence) will be reduced by 50% relative to 1990 By 2035: 95% reduction in tuberculosis deaths (compared

with 2015)

Partners More than 1200 partners Governments, communities and civil society , affected

people, NGOs, multilaterals, donors, technical agencies,private sector.

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TBfinancing

trendsDomestic and international donor funding

(excluding research and development for new tools)

Domestic87%

International13%

Domestic$5.3 billionFunding gap

$2 billion

International$0.8 billion

WHO 2013 Global Tuberculosis Report;

Africa48%

Asia: Other30%

Rest ofWorld15%

Asia: Low-income, high

burden7%

Funding gaps in 125 countries96% of global burden, 2013

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TBfinancing

trendsInternational fundingInternational funding gaps per region per

year

Africa$930 million

Europe $200 million

Eastern-Mediterranea n

$160 million

Western-Pacific

$150 million

South-EastAsia

$150 million

Americas$30 million

WHO and Global Fund to Fight AIDS, TB and Malaria March 2013 news release - Urgent need for US$ 1.6 billion a year ininternational financing to prevent spread of disease

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TBfinancing

trendsTotal international donor funding per

year

TB$0.8

billion

Malaria$1.8 billion

HIV$8.2 billion

Percentage of total international donorfunding from the Global Fund per year

TB82%

Malaria50%

HIV21%

WHO, 2013Global Tuberculosis ReportThe Global Fund to Fight AIDS, Tuberculosis and Malaria website

International donor funding accounts for 50% or more of total fundingin 17 of the 22 High TB Burden Countries (excludes BRICS, which

make up the other 5)

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TBfinancing

trends

Funding for R&D new tools2012

Drugs

38%

Basic Science21%

Vaccines14%

Operationalresearch

12%

Infrastructure8%

Diagnostics7%

$0.6 billion total

R&D funding$0.6 billon

Funding gap$1.4 billion

Treatment Action Group 2013 Report on Tuberculosis Research Funding Trends, 2005 2012

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TB is not just a health issue

But a global economic and security risk

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economicchallenge micro-

economic impact of TB onhouseholds

50%decrease inyearly income

of schoolchildren quitschool whenparent has TB

11%of income lostwith TB death15 yrs

Rajeswari R, Balasubramanian R, Muniyandi M, Geetharamani S, Thresa X, Venkatesan P, 1999. Socio -economic impact oftuberculosis on patients and family in India. Int J Tuberc Lung Dis 3: 869 877.Stop TB Partnership. (2000). Tuberculosis and Sustainable Development.

Up to

75%must take out aloan

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US$ 8billion

Estimatedeconomicburden of TB peryear in the EUalone

of TB patientsare in their mostproductive years

economicchallenge

75 %

Source: www.tballiance.org/why/economic-impact.phphttp://www.who.int/tb/careproviders/ppm/workplaces/en/index.html

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Return on investment for every one dollarspent on the most cost-effective health interventions

Tuberculosiscase finding& treatmentUS$ 30

HIVcombination prevention

US$ 12

local surgicalcapacityUS$ 10

heart attacksacute low-cost management

US$ 25

expandedimmunization

US$ 20

malariaprevention & treatment

US$ 20

Economicopport-

unity

Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, 2013

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What weneed

Attention and support to TBBy world leaders, country governments and YOU In the post-2015 agenda For development of the next Global Plan to stop TB 2016-

2020

Increased domestic funding Particularly for high burden and middle income countries

Increased external funding Increased funding for high-impact programs in addition toGlobal Fund

Set up an additional channel of fundinge.g. for innovations in care delivery

Funding for research on new tools

Integration within countries systems Walk away from vertical interventions Cross cutting areas procurement and supply, health

information systems, service delivery peripheral level

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How wecan help

Connect to relevant in country partners Support on prioritization of areas in need for

support Engagement of "non traditional" partners

communities, civil society, private sector Global Fund- NFM related events, activities- TA TB REACH

Challenge Facility for Civil Society GDFEmail us: ditiul@stoptb.who.int

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