London: The fight to curb the global tuberculosis epidemic has slowed to a crawl, threatening efforts to control the disease, the World Health Organization says in a report.
The worldwide rate of TB infection has been declining since it peaked several years ago. But between 2005 and 2006, the rate of new cases fell by less than 1%. Ideally, health officials want to see yearly decreases of 5-7%.
At the same time, WHO said last month that drug-resistant TB is growing faster than ever. Independent health experts criticized the WHO’s TB policy as being too passive, and urged a more proactive strategy.
WHO conceded that the most recent decline in the overall infection rate is less than 1% and which is also very modest, not as fast as it ought to be,” Dr Marcos Espinal, executive secretary of the organization’s ‘Stop TB Partnership’, said Monday.
“Without new tools, we will not be able to break the back of this epidemic,” he said, citing a lack of vaccines, drugs that need updating, obsolete diagnostic tests and overwhelmed health systems as contributing to the slowdown in eradication.
In 2006, there were an estimated 9.2 million new tuberculosis cases and 1.5 million deaths, the WHO said in its report, based on government data from 202 countries and regions.
India and China have the most cases, followed by Indonesia, South Africa and Nigeria, the report says.
By region, Asia has 55% of cases, and Africa has 31%. WHO admitted its treatment programmes “have not yet had a major impact on TB transmission and incidence around the world,” says the report, which assessed the WHO’s efforts for the past 12 years in which the agency has been issuing yearly reports.
WHO primarily works by recommending how governments and donors can best fight TB, and it is up to individual countries how they spend their funds. Last year, countries and donors spent about $2.3 billion on TB control. This year, WHO estimates that $3.1 billion is needed to identify and treat TB patients.
The report did offer some good news, saying TB infection rates had fallen in some regions. In Europe, however, infection rates were stable, while in Africa they were still increasing as the AIDS epidemic fuels transmission. TB in Africa has increased at least five-fold since the 1990s.
The report says 30 million people or 84.7% of identified TB patients have been cured through treatment. That was near the WHO’s 85% target.
Espinal acknowledged that WHO may not have enough evidence to show that its treatment strategy actually cuts transmission. The strategy works to cure people, he said, not necessarily to reduce the disease’s spread.
Experts countered that if treatment rates were as high as WHO claimed in the report, there would be less drug-resistant tuberculosis.
Last month, WHO said drug-resistant TB was spreading faster than ever. Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5% of the 9 million new TB cases, WHO said.
Independent experts also criticized the WHO’s reporting, saying it did not take into account those who are infected but not diagnosed, and was gathered from governments without being verified independently.
“This is a compilation of what the countries want to show,” said Dr Francis Varaine, coordinator of Medecins Sans Frontieres’ Tuberculosis Working Group. “Some of these data are too good to be true.”
In developing countries, WHO’s main tuberculosis treatment program depends on patients voluntarily being tested for the disease, instead of doctors actively seeking out patients.
WHO’s Espinal estimated that only about 60% of infected patients are diagnosed. “By the time a TB patient turns up, they have been coughing for weeks and have probably infected most of their family, friends, work mates and anyone else they were in contact with,” said Ruth McNerney, a tuberculosis expert at London’s School of Hygiene and Tropical Medicine. She said WHO’s strategy was “like shutting the door after the horse has bolted.”
Experts predicted that, despite WHO’s planning, tuberculosis numbers would continue to rise. “We are not going to make it with the current strategies,” said Varaine, of Medecins Sans Frontieres. “To think this epidemic will be turned around soon is like science fiction.”