Tuberculosis (TB) in 2015 sickened an estimated 10.4 million people around the world, a jump of 500,000 from 2014, and killed 1.4 million—more than HIV. But the apparently alarming rise mainly reflects improved surveillance in India, which accounts for 24% of the world’s cases, says an annual tuberculosis report released this week by the World Health Organization (WHO). The report also emphasizes that the world has made scant progress against multidrug-resistant TB, and that it doesn’t spend enough on diagnosis and treatment for this curable disease.
Mario Raviglione, head of the TB program at WHO in Geneva, Switzerland, says India long has been “a major problem” because it has 400 million people living in poverty. The poor often share rooms—easing the spread of the disease—and have little access to health care. Poorer people in India also sometimes depend on alternative treatments like Ayurvedic medicine that keep them away from proven cures—and official reporting of disease. One of the reasons for the increased detection in India, Raviglione says, is that nongovernmental organizations are linking traditional caregivers to “the proper system” that does evidence-based detection and treatment.
Six nations—India, China, Indonesia, Nigeria, Pakistan, and South Africa—account for 60% of the total TB cases in the world. “The rate of progress in these countries will have a major influence on whether or not” public health experts reach 2020 goals for fighting the disease, the report states. Those milestones include reducing the number of new cases and deaths in 2015 by 20% and 35%, respectively.
The report repeatedly refers to “gaps.” There are gaps in the number of cases reported to WHO and the estimated true burden (6.1 million reported cases versus 10.4 million estimated cases). Only 125,000 of the estimated 580,000 people eligible to receive treatment for multidrug-resistant TB are enrolled in treatment programs. WHO recommendations call for prophylaxis treatment of all HIV-infected people with the TB drug isoniazid, but just nine of the 30 countries that have the highest TB/HIV coinfection rates report any preventive treatment.
Perhaps the most critical gap is funding. The report says the world must increase its 2016 investment of $6.6 billion in fighting TB by $1.7 billion a year in low- and middle-income countries to properly combat the disease. Raviglione notes that the many people developing TB live in middle-income nations, including the so-called BRICS nations of Brazil, Russia, India, China, and South Africa, and that these countries already cover 84% of their own TB expenses. But they have trouble finding additional resources. “We have a vicious cycle that doesn’t allow these countries to get more money domestically, and international money won’t come to them,” he says. “We have to find a different mechanism to support them.”
Raviglione says ministers of health in these countries have tried to convince their governments to invest more in TB, but it’s a hard sell. “The ministers of health are not the right people to talk to—it’s the ministers of finance and prime ministers,” he says. “We have to elevate the discussion.”