WHO reports 1.7 million TB deaths in 2016

Almost 1.7 million people died of TB in 2016, according to the World Health Organisation’s latest World TB Report, published early in November. This means that TB remains the leading  cause  of death from  a single infectious agent. Of the almost 1.7 million deaths, 1.3 million were of people who did not have HIV, and 374 000 were of people who were living with HIV.

India remains the epicentre of the global TB epidemic, with 26% of worldwide TB deaths in 2016. India also had the most TB cases, followed by Indonesia, China, the Philippines and Pakistan.

According to the report, an estimated 124 000 people in South Africa died of TB in 2016 – of these, 101 000 had HIV, and 23 000 did not.

10.4 million fell ill with TB

The report also found that  in 2016, an estimated 10.4 million people around the world fell ill with TB. Of these people, 90% were adults, 65% were male, and 10% were people living with HIV. Globally, 83% of people with TB are treated successfully.

In South Africa there were around 438 000 new TB cases in 2016. Of these, 182 000 were in women and 256 000 in men. This means that around 58% of new TB cases were in men; thus, while still skewed toward men, the TB epidemic in South Africa is less skewed than elsewhere – probably as result of South Africa’s high HIV rates, and the fact that HIV rates are higher in women than in men.

The DR-TB epidemic

In 2016, an estimated 600 000 people around the world newly acquired TB resistant to rifampicin (one of the most effective TB drugs). Of these, 490 000 people’s TB was also resistant to another critical TB drug, called isoniazid (TB that is resistant to these two drugs is called multi-drug-resistant TB, or MDR-TB). Almost half (47%) of these cases were in South Africa’s BRICS partners: India, China and the Russian Federation.

According to the report, South Africa had around 19 000 cases of MDR- or rifampicin-resistant (RR) TB. Only around 11 000 of these people received treatment. Disappointing as that is, the global picture is even worse – a total of 129 689 people were started on treatment, a small increase from 125 629 in 2015. This figure amounts to only 22% of the people who need treatment. And for those lucky enough to receive treatment for MDR- or RR-TB, unfortunately, treatment success remains low, at a miserly 54% globally.

South Africa remains a leader in the provision of TB-preventive therapy. Globally, around 940 000 people newly started on antiretroviral therapy were also provided with TB-preventive therapy. Of these people, 41% (about 385 000) were in South Africa. For this, the South African National Department of Health deserves credit.

Not good enough?

The report found that the global number of TB deaths is falling by around 3% per year, and the global number of new infections by about 2%. Currently, about 16% of people who get TB die of the disease. To meet the targets of the WHO’s End TB Strategy, this number must drop to 10% by 2020. The death rate and the rate of new infections will both have to drop by about 5% per year by 2020. The End TB Strategy aims for a 90% reduction in TB deaths and an 80% reduction in new infections per year by 2030 (compared to 2015).

 “Overall, the latest picture is one of a still-high burden of disease, and progress that is not fast enough to reach targets or to make major headway in closing persistent gaps.” – 2017 WHO World TB Report

The report goes on to recognise that “the WHO Global Ministerial Conference on ending TB in the SDG era in November 2017 and the first UN General Assembly high-level meeting on TB in 2018 provide a historic opportunity to galvanise the political commitment needed to step up the battle against TB, and put the world and individual countries on the path to ending the TB epidemic”.

While not explicitly stated in the report, one critical test of political commitment in these multinational forums will be the concrete financial investments governments do or do not make in TB research and development (R&D). Currently, global annual investment in TB R&D is only around a third of the annual $2bn that the WHO estimates is needed. According to the report, ”Increased investment in research and development is needed for there to be any chance of achieving the technological breakthroughs needed by 2025.”