Governments accused of not doing enough after World Health Organisation figures show more TB cases than previously thought

Tuberculosis is killing more people than thought, yet governments are not doing enough to bring the debilitating infectious disease under control, the World Health Organisation has said.

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The latest WHO figures show TB has been taking a much greater toll in India than previously believed and that the number of cases worldwide last year was 10.4m , up from the 9.6m estimated before more detailed investigations were done.

The disease claims the lives of 1.8 million people worldwide each year, not the 1.5 million it was previously thought.

Drug-resistant TB, which is more difficult and very expensive to treat with combinations of the latest antibiotics, has also risen, to more than half a million cases globally.

Dr Margaret Chan, director general of the WHO, warned that much more needed to be done if the world was to have any hope of stopping the disease in its tracks.

“We face an uphill battle to reach the global targets for tuberculosis,” she said. “There must be a massive scale-up of efforts, or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed.”



The UN has set a target of cutting TB deaths by 90% and cases of the disease by 80% between 2015 and 2030.

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Unlike Aids and malaria, most TB cases are not in the poorest countries so there is less funding available from the rich nations, which donate through conduits like the Global Fund to fight Aids, Tuberculosis and Malaria only to the poorest – even though they face the threat of the disease which spreads in water droplets and cannot be confined to specific countries in an age of global travel.

The US does not have special funding for TB programmes as it does for HIV, whilethe EU puts in little by comparison with contributions for HIV and malaria.

Facebook Twitter Pinterest A doctor examines a tuberculosis patient in a government TB hospital in Allahabad, India. Photograph: Rajesh Kumar Singh/AP

India has about a quarter of all the cases in the world, followed by Indonesia and then China, which have about 10% each. Nigeria and Pakistan each account for 5% of cases and South Africa has a little less.

“These [six] countries have 60% of the burden. TB is not like malaria, which is 90% in Africa, or HIV,” said Dr Mario Raviglione, director of WHO’s global TB programme. “It is a disease of the Brics [Brazil, Russia, India, China and South Africa] and middle-income countries. We are talking of a disease that eventually is financed largely by domestic funding.”

But health ministers cannot argue the case for funds for TB with governments that feel they have other priorities. WHO is hoping that a meeting of the UN general assembly will be held to focus heads of state on what must be done to end the threat of TB.

“We are saying there is dismal progress on commitment,” said Raviglione. “TB is not something that will just come down if you have development. It is a dangerous game. It is not going to go away slowly. It will take generations.”

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The true scale of TB in India has remained hidden because no national survey has been carried out. The government has now agreed to conduct one but the results will not be known until at least 2019. But a survey in Gujarat, one of the richest Indian states, established a far higher prevalence of TB than had been thought and together with other evidence, it has been possible to come up with a better estimate than in previous years.

Work has been going on to encourage doctors in the private sector to report TB cases, which they are not obliged to do and have not done in the past. In the slums of Mumbai, Ayurvedic doctors and healers who see most of the patients have been encouraged to give out the free antibiotics to treat TB alongside traditional remedies, and to report the numbers of patients they see. A digital reporting system has been introduced with some success.

India wins praise from WHO but its actions have served to highlight the scale of the problem. Of the 10.4m cases worldwide, only 6.1m were detected and treated in 2015. Those undetected risk passing the bacteria that causes TB to their families. Countries do not have the rapid testing equipment they need.

There is particular concern over drug-resistant TB, which affects 580,000 people. Only half of those who get a strain resistant to the standard antibiotic combination of drugs survive. Only one in five of those with resistant TB get the newer combination of antibiotics that can cure it.

“We absolutely must solve the crisis of drug resistance – both treating it and preventing it by implementing basic TB programmes effectively,” said José Luis Castro, executive director of the International Union Against Tuberculosis and Lung Disease.

“There’s an effective new regimen available for treating multidrug-resistant TB and that needs to get to patients as quickly as possible. If we are to end the TB epidemic by 2035, we need to triple our rate of progress in a short period of time and that means tackling MDR-TB head on.”