The World Health Organisation's (WHO) strategy to control the worldwide rise of tuberculosis (TB) has not worked, say Harvard researchers in the Journal of Epidemiology and Community Health. It is time to go beyond simply treating people with active disease, which has been the cornerstone of its strategy, they say.
The WHO declared TB a global health emergency in 1993: a third of the world's population was thought to be infected at the time, with 7.5 million new cases and 2.5 million deaths from the disease every year. One in four preventable deaths in adults around the world was attributable to TB.
In the same year, the WHO introduced its 'directly observed therapy short course' (DOTS), in a bid to halve TB deaths over the next decade and curb the global epidemic.
Yet, say Dr Timothy Brewer and Jody Heymann from Harvard University, Massachusetts, USA, TB cases continue to rise, despite the introduction of 'DOTS-Plus', a programme aimed to tackle multiple drug resistance to TB strains. Where HIV is endemic, cases of TB have soared.
There is no historical precedent for the successful global elimination of an infectious disease based solely on treating people with known active disease to prevent transmission, the authors write.