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In the first update on tuberculosis
since the UN General Assembly
High Level meeting on Sep 26,
2018, in which All UN Member
States committed to end the global
tuberculosis epidemic by 2030, WHO
published the Global Tuberculosis
Report on Oct 17, 2019. The report
details data from 202 countries and
territories that account for more than
99% of the world’s population and
estimated the number of tuberculosis
cases. Ahead of the first 2020 mile­
stone, tuberculosis still accounts
for the highest mortality from any
infectious diseases world­
w ide,
even surpassing HIV/AIDs, causing
1·5 million deaths in 2018. According
to WHO’s report, the current pace
of change is not enough: the global
cumulative rate of reduction for
tuberculosis incidence was only 6·3%
between 2015 and 2018, which is
much less than that of the 2020
milestone of 20%.
Enormous intercountry variation
exists, with only eight countries
accounting for two thirds of the
global total of tuberculosis cases. The
report notes a concerning trend in
the rise of notifications of new and
relapsed cases: 7·0 million new cases of
tuberculosis in 2018, an increase from
0·6 million in 2017, and 1·2 million
since 2012. Most new cases between
2013 and 2018 are from India and
Indonesia, with new cases increasing
60% and 70%, respectively. India has
the highest number of cases in one
country (27%) and has ambitiously
set an earlier goal of 2025 to end
the tuberculosis epidemic; progress
of which would affect tuberculosis
goals worldwide. However, in a press
release from the Scientific Director of
The Union in response to this report,
Paula Fujiwara says that although
India is making some progress in
treatment, “progress is still too slow
to meet the targets—and if we don´t
www.thelancet.com/respiratory Vol 8 January 2020
end TB in India we can’t hope to end
tuberculosis globally”.
Small improvements in the coverage
of testing, detection, and treatment of
multidrug- and rifampicin-resistant
tuberculosis were noted with an
increase of bacteriologically confirmed
tuberculosis rising 10% from 2017.
Nevertheless, people with drugresist­­ant tuberculosis accounted for
more than half a million new cases
in 2018 and only one in three of these
were enrolled in treatment; albeit
an improvement on the one in four
reported in 2017. A vast proportion
(75%) of the gap between treatment
and new cases of drug-resistant
tuberculosis is in only ten countries.
The report attributes one of the
main reasons for the delay in progress
to the shortage in needed invest­
ment into tuberculosis prevention.
Christina Yoon, an Assistant Professor
at the School of Medicine, University
of California, San Francisco, agrees that
preventive measures and treatment
are where the underperformance
is greatest. “Scaling-up preventive
therapy and reaching the ‘missing’
3 million active tuberculosis cases are
still our biggest challenges, particularly
among children.” Other funding gaps
remain, such as that in tuberculosis
research in the USA, which fell
short of the UN high-level meeting
commitment by $1·2 billion in 2017,
and a huge annual funding gap overall
of $3·3 billion in 2019. Additionally,
international donor funding is far
below what is needed annually with
almost $1·4 billion less than estimated
in the initial Global Plan.
65 countries have initiated
tuberculosis prevention in people
living with HIV, of whom account
for almost 9% of all cases and
1·8 million people with tuberculosis.
The overall coverage in 66 countries
was 49%, which looks promising to
achieve the target of 6 million people
over 2018–22. Yet, the number of
household contacts had a much
smaller coverage, for example, only
27% of all the estimated 1·3 million
eligible children younger than 5 years.
As suggested in the report, Yoon
supports the idea that future research
can help to improve tuberculosis
care and the burden of new cases:
“This year’s report describes uptake
of the regimen 3HP in tuberculosis
endemic countries for the first time.
Although few tuberculosis endemic
countries reported using 3HP outside
of research settings, as routine use of
3HP increases over time, it will be very
interesting to see the impact of shorter
course preventive therapy regimens
on preventive therapy scale-up and TB
On a positive note, the overall
number of tuberculosis cases and
deaths are reducing year on year.
One WHO region (WHO Europe)
and seven high burden countries
(Kenya, Lesotho, Myanmar, Russia,
South Africa, Tanzania, and Zimbabwe)
are on track for the 2020 milestone;
incidence and related deaths also
reducing relatively fast in the WHO
African Region.
Although progress is being made,
investment into prevention, care, and
research needs to double each year for
the next 3 years. Financial provisions
need expanding for the substantial
costs of tuberculosis on patients and
their contacts, and a focus on access
to care and preventive treatment,
with a movement towards increasing
use of molecular tests to bio­log­
ically confirm the disease. Overall a
multisectoral approach is essential
to reaching the 2020 milestones.
The next evaluation of these goals
will be at the UN Secretary-General’s
Assembly, which is expected to be
held in September, 2020.
TEK Image/Science Photo Library
WHO global progress report on tuberculosis elimination
Published Online
November 6, 2019
This online publication has
been corrected.
The corrected version first
appeared at thelancet.com/
respiratory on November 15,
For the WHO Global
Tuberculosis Report 2019 see
For the Union response see
Emilia Harding