Tuberculosis: 20 Years in a State of Global Emergency

An estimated one-third of TB cases are never diagnosed and/or recordedThe control of tuberculosis (TB) is at a critical juncture. Despite the progress made in recent years, TB still causes over 4,000 deaths a day on our planet, an unacceptably high figure, particularly since almost all of those deaths are preventable. It has been more than 20 years since the World Health Organization (WHO) declared TB to be a global public health emergency, a step that raised awareness among health authorities worldwide of the need to invest more and make a concerted effort to respond to a disease with an annual incidence of 9 million cases that killed 1.5 million people last year. Since then, the campaign that has prevented millions of cases of TB and deaths over the last two decades has been based on four pillars: greater investment by governments and international health agencies; reorganization and strengthening of national TB control programmes; increases in resources for research; and the implementation of harmonized international control strategies.

While the statistics show a decline in the number of cases of TB sensitive to current standard therapies, they also reveal an increase in multidrug-resistant TBBut we cannot afford to rest in the fight against tuberculosis. While some countries with a low incidence (fewer than 10 cases per 100,000 people) have ambitions to eliminate the disease, others—mostly the very poor countries—are looking at a bleak scenario (more than 500 cases per 100,000 people) with no prospect of improvement and no resources to deal with a bacterial infection that hinders the economic and social development of the regions most affected. While the statistics show a decline in the number of cases of TB sensitive to current standard therapies, they also reveal an increase in number of cases of the type of TB that does not respond to either of the best therapies, which is called multidrug-resistant TB (MDR-TB). In MDR-TB, patients and health systems have to deal with much longer courses of treatment (up to two years), which cause more side effects and are up to 100 times more expensive. Despite the improvement in surveillance systems in most countries, an estimated one-third of TB cases are never diagnosed and/or recorded , a problem that makes it difficult to speed up the reduction in the number of cases. Transmission hot spots, such as mines and prisons, present a formidable challenge for the control of disease transmission in the general population. In HIV-positive or diabetic patients, two populations particularly susceptible to TB, successful treatment is more difficult, and the need to manage concomitant diseases complicates the therapeutic approach. To meet these challenges, more money is needed—about two billion more than is currently spent annually by some estimates.

The annual world conference of the International Union Against Tuberculosis and Lung Disease held in Barcelona earlier this month brought together thousands of TB experts from more than 120 countries, who presented the latest research on tuberculosis and raised awareness about the importance of maintaining and increasing spending on TB control and research. The participants were health professionals, scientists, ministers of health, social workers, and activists. They discussed strategies aimed at enhancing the visibility of this devastating disease—visibility that could result in an increase in political commitment and investment from both national governments and international institutions. We must not forget that TB is a global health problem affecting, to a greater or lesser extent, all the countries in the world, which means that action must be taken on a global scale. Otherwise, we will continue to fail collectively, perpetuating the excessive and unacceptable burden that TB continues to inflict today.