1. Technical Advisory Group meeting, WHO/WPRO
The End TB Strategy Role of WHO in supporting implementation of the new global strategy
Philippe Glaziou, on behalf of Mario RAVIGLIONE, Director
Technical Advisory Group meeting, WHO/WPRO
Manila 9-12 December 2014

2. Global Burden of TB in 2013 1.5 million 9 million 480,000
Estimated number of cases
Estimated number of deaths
1.5 million
80,000 in children
510,000 in women
9 million
126 per 100,000
550,000 in children
3.3 m in women
480,000
All forms of TB
Multidrug-resistant TB
HIV-associated TB
1.1 million (13%)
360,000
210,000

3. TB cases and deaths, 1990–2013 9 million incident cases in 2013
5.7 million reported to WHO
1.5 million deaths in 2013
All cases
HIV-negative
HIV-positive cases
1.1m
HIV-positive

4. 480,000 MDR-TB, 9% with XDR Highest % in the former USSR countries
India, China, Russia, Pakistan and Ukraine
have 60% of all MDR-TB cases

5. Accelerated MDR detection, but widening treatment gap
136,000 detected (2013)
Accelerated MDR detection, but widening treatment gap
97,000 treated (2013)

6. 48% MDR treatment success globally

7. MDR-TB: Five priority actions

8. 78% of TB/HIV cases in Africa
Response to TB/HIV means cutting transmission and mortality
78% of TB/HIV cases in Africa
Other co-morbidities emerging in other regions

9. 48% global HIV testing coverage, 76% in Africa

10. Intensifying research
The needs are clear:
Understand pathogenesis & immunity
PoC diagnostic tests
Short regimens incl. for LTBI
Post-exposure vaccine
Epidemiological, health system, implementation research

11. Funding gap US$ 8 billion per year required for the response
US$ 2 billion gap
US$ 2 billion required for R&D
Cost per case US$
Cost per MDR case US$ 9,000-49,000

12. Global progress on impact - 2014
TARGETS ON TRACK
Reduction in TB mortality rate of 45% since 1990
37 million lives saved since 2000
86% cure rate and 61 million patients cured,
BUT….
incidence falling too slowly at 1.5%/year

13. Challenges: 5 priorities for action
5 PRIORITIES TO ELIMINATE TB
Reaching the “missed” cases
(3 million not in the system)
Address MDR-TB as crisis
Accelerate response to TB/HIV
Increase financing to close
resource gaps
Intensify research and ensure rapid uptake of innovations

14. 67th World Health Assembly, Geneva, May 2014

15. Global projections to 2035

16. The End TB Strategy: Vision, goal, targets
Vision: A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB suffering
Goal: End the Global TB epidemic (<10 cases per 100,000)
Target 1
95% reduction in deaths due to TB (compared with 2015)
Target 2
90% reduction in TB incidence rate (compared with 2015)
Target 3
No affected families face catastrophic costs due to TB

17. 3 pillars and 4 Principles
Bold policies and supportive systems
Integrated, patient-centered TB care and prevention
Intensified research and innovation
Government stewardship and accountability, with monitoring and evaluation
Building a strong coalition with civil society and communities
Protecting and promoting human rights, ethics and equity
Adaptation of the strategy and targets at country level, with global collaboration

18. The End TB Strategy components
1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
Early diagnosis, universal DST, screening of contacts and high-risk groups
Treatment of all, including DR-TB, patient support
Collaborative TB/HIV activities, management of co-morbidities
Preventive treatment of persons at high risk, vaccination against tuberculosis
2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
Political commitment, adequate resources for tuberculosis care and prevention
Engagement of communities, civil society, and public and private care providers
Universal health coverage policy, regulatory frameworks for notification, vital registration, rational use of medicines, infection control
Social protection, poverty alleviation and actions on other determinants of TB
3. INTENSIFIED RESEARCH AND INNOVATION
Discovery, development, rapid uptake of new tools
Research to optimize implementation, impact - promote innovations

19. “Global Consultation Towards Elimination of Tuberculosis in
Countries with Low Incidence of Disease”
Rome, 4-5 July 2014
Countries with < 10/100,000 TB cases/year, notified all forms cases & > 300k population
Other countries progressing rapidly or with potential to consider elimination in the future

20. Targets for low-incidence countries
<100 cases per million
Current TB burden-2012
in low-incidence countries
<10 cases per million
Pre-elimination: 2035
in low-incidence countries
<1 case per million
Elimination: 2050

21. Way forward: What will WHO do globally?
Norms, strategies and policies
Global M&E for impact and progress
Adaptation towards elimination in low-incidence countries
Support ROs' efforts in adopting & adapting
Guidance on adoption and adaptation of the new strategy
Access to innovations
Focus on the most vulnerable populations
Multi-sectoral partnerships for social protection
Promotion of research and innovation
Advocacy and promotion of the new strategy
Investment plan with partners for resource mobilization
Investment plan

22. What will WHO do in countries?
Technical assistance to adapt, plan, and
implement the new strategy with focus on:
Vulnerable communities
Missed cases, TB/HIV and MDR-TB
Monitoring & evaluation
Research, application of innovations
Social development
Support in resource mobilization
Partnership with GF on TA for epidemiological assessment, programme reviews, NSP, and concept note development
Partnership with UNITAID to strengthen diagnostic capacity and access to new/essential commodities
Close collaboration with other international donors

23. Conclusions
Global achievements also depend on success in the regions, especially WPR, with nearly 20% of the global burden
Reaching the 2025 and 2035 targets in WPR requires…
In middle- and high-incidence countries: full adoption, financing and implementation of the new End TB Strategy;
In low-incidence countries, TB Elimination Action Framework, intensified support to higher-incidence countries
WHO’s Global TB Programme committed to support all efforts by countries in WPR and by WHO/WPRO to make TB elimination a reality