On Oct. 26, 2016, The Economist Intelligence Unit (EIU) announced the publication of a report that notes: Although tuberculosis (TB) "was responsible for around 1.5m deaths in 2014, down from nearly 1.8m in 1990, it is now the leading infectious disease killer worldwide, surpassing HIV/AIDS," according to the World Health Organization. The EIU report is intended to serve as an update to a 2014 report, Ancient enemy, modern imperative: A time for greater action against tuberculosis. This post, however, will focus on the 2014 report, which investigates the health challenge posed by TB and ways to improve the effectiveness of the global response to it. I will address the findings from the 2016 report in a subsequent post on this blog.
Supported by Janssen, the EIU's 2014 report "draws on interviews with 17 public health officials, funders, academic and medical experts, researchers, and activists as well as on extensive desk research to consider the state of the TB challenge, barriers to further progress, and how efforts need to evolve." The report's key findings include the following:
- Despite important successes, progress against TB is still slow and significant weaknesses remain;
- Drug-resistant TB has become a public health crisis that is receiving too little attention and shows up failings in current efforts;
- To date, TB efforts at various levels have often suffered from a lack of compelling ambition and interest;
- A high level of stigma still affects those with the disease and hampers efforts against it;
- Efforts against TB remain overly provider-centered and set apart from health systems; and
- Improved success against TB will require changes on a number of levels.
On the topic of improving success against TB will required changes on a number of levels, the report says that "further progress against TB is essential, but will mean new strategies that address current weaknesses while not throwing away gains to date." These new strategies include:
- Finding and treating people where they live. To find the nearly-3m new cases of TB every year, health systems in countries with a high incidence of TB need to look across the entire population, and even those with a lower prevalence have to find better ways of going into, and working with, sometimes marginalized populations;
- Taking TB control out of existing silos. TB needs to treat the whole person, including addressing common co-morbidities such as HIV/AIDS, and co-ordinating public and private health provision;
- Harnessing cost-effective technology. Although progress in the field of TB remains frustratingly slow, new tools available today—both medical and non-medical—have the potential to transform treatment;
- Raising the profile of TB. Perhaps most important, activists and other stakeholders must find better ways to elevate national and global ambitions to deploy the tools at hand with sufficient intensity to make more rapid progress against this disease.
The 2014 report concludes by stating "TB strategies need to move in practice beyond medical silos to work in and with communities on finding cases and improving treatment outcomes. This involves a range of changes, including those listed below:
- Seeking and treating the ill in new ways, where they live. Clinic-based efforts alone will not reach the nearly 3m undiagnosed TB cases. In high-burden countries, the search will need actively to look for TB across the population as a whole. Even in lower burden ones it will involve finding effective ways to target and treat the disease in sometimes challenging marginal populations;
- Integrating care to take account of the whole human being. Those with TB frequently have co-morbidities and lack the social or economic resources to be able to complete their treatment—especially of MDR TB—over the long term. Effective TB care means finding ways to overcome these barriers;
- Taking advantage of the resources of health systems as a whole. National TB programs are an effective way to focus attention on the disease, but they should not become a TB care silo. The whole health system needs to be involved in finding TB, and medical facilities— including HIV clinics and private care providers— are proven ways to help address the disease; and
- Harnessing new technology (both medical and non-medical). Medical advances in TB are still frustratingly slow, so those that come along need to be applied in the most useful way. The WHO has encouraged the use of GeneXpert and such a test will be essential in rapidly diagnosing and defeating MDR TB. Health systems need not rely solely on medical technology, however. Mobile information technology and integrated databases show great promise in being able to understand the challenge that TB poses at both national and local levels, as well as in tracking patients and helping to avoid issues with drug stocks.
A video produced in conjunction with the 2014 report, which may be viewed below or through this link, correctly explains that "combating tuberculosis globally required finding and treating people where they live, involving the health system as a whole, and harnessing cost-effective technology."