Slide 1Dr Tauhid ISLAM Coordinator End TB & Leprosy WPRO/WHO
End TB: Global and Western Pacific Regional
Experiences
Context
All Member States of WHO and the UN have committed to WHO’s End TB Strategy (in 2014) and the SDGs (in 2015)
Common aim: end the global TB epidemic
From “halting TB” to “ending TB”
Placing at the centre all people vulnerable to, or affected by, TB
Translating quest for UHC
systems
“All of society” approach to end, not just “all of government”
Usually whole-of-society Whole-of-governement
Changing paradigm
INDICATORS MILESTONES TARGETS
2020 2025 2030 2035
1. Reduction in number of TB deaths compared with 2015 (%) 35% 75% 90% 95%
2. Reduction in TB incidence rate compared with 2015 (%)
20% 50% 80% 90%
3. Percentage of TB patients and their households facing catastrophic costs due to TB
Zero Zero Zero Zero
Incidence
45% per year by 2020
10% per year by 2025
UHC and action on determinants
R&D
Headline numbers:
10 million new cases in 2017 (uncertainty interval 9.0–11.1 million)
558 000 new cases of rifampicin-resistant TB (uncertainty interval, 483 000–639 000)
Notified 160,684 - Enrolled 139,000 (Only 25% had access to treatment)
Treatment success rate for MDR/RR-TB only 55% in 2015
1.8 million new cases in 2017 (uncertainty interval 1.5–2.1 million)
114 000 new cases of rifampicin-resistant TB (uncertainty interval 89000–142000)
Notified 24,699 – Enrolled 16,054 (Only 14% had access to treatment)
Treatment success rate for MDR/RR-TB only 53% in 2015
Global situation of DR-TB Regional situation of DR-TB
TB is one of the ten leading cause of death worldwide
Millions in 2016
Ischaemic heart disease
0 1 2 3 4 5 6 7 8 9
Cancer: tracheal, bronchus, lung
Road injuries
Diarrheal diseases
87% in 30 high TB burden countries 8 countries had two third of cases in 2017 18% cases in the Western Pacific Region
100k 500k 1 million
Bangladesh
circles shown for countries with at least 100,000 incident cases in 2017 8 countries with Red Font * More than 500/100K incidence rate
91% in 30 high MDR-TB burden countries 3 countries with almost 50% cases
3.5% of new and 18% of previously treated cases had MDR/RR-TB
Number of incident cases
100 000
150 000
circles shown for countries with at least 1000 incident cases in 2017
India
China
Progress in reducing TB disease burden
TB disease burden is falling globally, in all WHO regions and in most countries, but not fast enough to reach the
2020 milestones of the End TB Strategy
Globally, TB incidence falling at about 2% per year
Rate of decline needs to increase to 45% per year by 2020
R at
e pe
0 2000 2005 2010 2015 2017
Good news in southern Africa TB incidence falling at 4–8% per year
as ART coverage has risen Botswana Eswatini*
*formerly Swaziland
40
60
80
100
100
80
60
40
2010 2012 2014 2016 2010 2012 2014 2016 2010 2012 2014 2016
Global estimates of TB deaths, 2000–2017 Case fatality ratio (CFR) 16% globally in 2017, Needs to be reduced to 10%
by 2020 ,
1.5
0.5
0
1.0
1.3
0.3
1.8
0.5
TB mortality, 2000–2017
Falling at 13% per year 2013–2017
xxx raw data from national vital registration system
Case notifications increasing but large incidence: notification gap
N um
Incidence
10.0
6.4
36% Globally, 25% gap in Western Pacific Region
Drug-resistant TB: treatment enrolments and gaps One in 4 had access to Tx Globally, One in 5 in this Region
N um
Enrolled on treatment 139,000 in 2017, 130,000 in 2016
Detected
Incidence
Gap
558,000 (uncertainty interval, 483 000–639 000)
Concern on quality in scaling up: Treatment outcomes has not kept pace
Globally, treatment success rate for MDR/RR-TB only 55% in 2015
2015
2014
2013
2012
Successfully treated
Not evaluated
Treatment failed
People living with HIV
s
30% Globally, coverage ranged from 1% to 53% in countries that reported data
38% in the Western Pacific Region
Children <5, household contacts 292,000 treated in 2017
23% of the estimated 1.3 million eligible
17% in Western Pacific Region
0
250
500
750
1000
Universal health coverage and
TB determinants At least half of the world’s population lacks access to essential health and almost 10% of the world’s population – experience catastrophic expenditures on health.
SDG indicators for UHC: status in HBCs Essential health services coverage index (0–100)
% households facing catastrophic expenditures on health
Brazil China
Zimbabwe
National TB patient cost surveys % facing catastrophic costs shown in centre
Estimated global number of TB cases attributable to 5 risk factors
% below international poverty line
% covered by social protection Prevalence of
undernourishment % on clean fuels and energy GDP per capita % income inequality % living in slums
Broader influences matter: demand multi-sectoral response
TB research and development
The SDG and End TB Strategy targets set for 2030 cannot be met without intensified research and development
• Diagnostics – No new platform – No single rapid point of care
test • Drugs
– 11 new drugs compound/repurposed drugs/regimens (Phase 2)
– 13 new drugs compound/repurposed drugs/regimens (Phase 3)
• Vaccines – 12 vaccines in different phases
• Funding requirement for TB R&D estimated at about US$2 billion per year
• Funding for TB R&D reached US$724 million in 2016, 36% of what is needed
Current status of TB R&D pipelines Progressing, but slowly; more investment needed
Where are we?
• Burden of TB disease still high, affecting all countries, all ages, men, women and children
• Progress, but slow - not fast enough to reach milestones or make major headway in closing persistent gaps
• Quality remains a major concern
Western Pacific
Regional experience:
• 1 in 4 estimated cases are missed in the Region
• 532 million (Estimated) LTBI (28% prevalence)
• More than 100,000 new DR-TB cases each year and less than 25% access the treatment
• 35-70% TB affected person and families faced catastrophic cost
• No structured multi-sectoral accountability
• Unprecedented economic growth and urbanization in the Western Pacific Region
• Rapid development also has fueled greater inequity
• Some countries’ populations are rapidly getting older
New emerging challenges
Urbanization in WPR
RURAL URBAN 0
6 out of the 10 largest megacities are in WPR
Ageing population in WPR
10%
20%
14%
25%
New priorities
Changing Funding Landscape • Health financing modalities
Flourishing for Profit Private Sectors • Revamped PPM framework with new tools
Rapid Urbanization - Internal Migration • Strengthening migrant health framework
Increase in Non-communicable Diseases; Air Pollution • Coordination with other health programs
Population Ageing • Targeted comprehensive package of patient-centered care including co-
morbidity management
6. Grounds up
Opportunities
Mongolia Epidemiological Review
Manila Updated Policy - DR-TB and LTBI
Philippines Race to End TB
Acknowledgements All National TB Control programmes
>500 people who contributed to reporting and review of data
Core Report Team Laura Anderson, Annabel Baddeley, Monica Dias, Katherine Floyd, Inés Garcia Baena,
Nebiat Gebreselassie, Chris Gilpin, Philippe Glaziou, Irwin Law, Nobu Nishikiori, Molebogeng Rangaka, Andrew Siroka, Charalambos Sismanidis, Lana Syed, Hazim Timimi,
Yinyin Xia, Matteo Zignol
Other staff at WHO HQ and Regional Offices Mohamed Abdel Aziz, Edith Alarcon, Samiha Baghdadi, Andrei Dadu, Masoud Dara, Dennis Falzon, Michel Gasana, Jean Iragena, Tereza Kasaeva, Giorgi Kuchukhidze, Rafael Lopez- Olarte, Partha Mandal, Casimir Manzengo Mingiedi, Ernesto Montoro, André Ndongosième,
Wilfred Nkhoma, Kalpesh Rahevar, Mukta Sharma, Diana Weil, Karin Weyer
Funding USAID, Bill & Melinda Gates Foundation,
governments of Japan, Republic of Korea, Russian Federation
It’s
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Headline numbers:
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91% in 30 high MDR-TB burden countries 3 countries with almost 50% cases3.5% of new and 18% of previously treated cases had MDR/RR-TB
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Good news in southern Africa
Global estimates of TB deaths, 2000–2017 Case fatality ratio (CFR) 16% globally in 2017, Needs to be reduced to 10% by 2020,
Faster declines at country level e.g. Russian Federation
Case notifications increasing but large incidence: notification gap
Drug-resistant TB: treatment enrolments and gapsOne in 4 had access to Tx Globally, One in 5 in this Region
Concern on quality in scaling up:Treatment outcomes has not kept pace
Globally, treatment success rate for MDR/RR-TB only 55% in 2015
Treatment for latent TB infection, two priority risk groups
Slide Number 21



Old Common Challenges
New emerging challenges
Urbanization in WPR