Lancet special series examines TB worldwide

The Lancet released on Wednesday a special series on tuberculosis, which includes a series of papers and comments highlighting the need for new tools, the threat posed by drug-resistant strains, results of current control efforts and other issues about TB worldwide, Agence France-Presse reports.

One article notes that global treatment strategies prevented six million deaths and successfully treated 36 million cases of the disease between 1995 and 2008 (5/18). "Yet tuberculosis remains a severe global public health threat. There are more than 9 million new cases every year worldwide ... Although the overall target related to the Millennium Development Goals of halting and beginning to reverse the epidemic might have already been reached in 2004, the more important long-term elimination target set for 2050 will not be met with present strategies and instruments," the authors of the study write (Lonnroth et al., 5/19).

The journal highlighted the gaps in funding required to improve TB control, AFP writes. At the launch of the report in Geneva, Mphu Ramatlapeng, Lesotho's health minister, remarked, "Tuberculosis is unfashionable these days." Researchers said, "Tuberculosis can no longer be the neglected sister of HIV and malaria," AFP reports.

One article warns that the absence of major investments in new technology and prevention and treatment tools could make drug-resistant strains of TB the "dominant" form of TB over the coming decades, according to the news service (5/18). The article notes "that India and China had around 50 percent of the global MDR-TB burden, followed by Russia with 9 percent," Reuters writes. The authors write, "The future possibility of strains that are totally resistant to all anti-tuberculosis drugs is not inconceivable."

"In other studies in the series ... scientists said the combined impact of new drugs, vaccines, and diagnostic tests could cut worldwide incidence of TB by 94 percent by 2050," the news service reports. According to experts, only about a quarter of the funding needed for drug research and development is available.

"Development of new drugs for TB is lengthy, expensive, and risky, and the expected revenues are too small to justify commercial investment," Zhenkun Ma of the Global Alliance for TB Drug Development and co-authors write in a paper. "New financing and market incentive mechanisms are needed."

The journal also notes that "there are 11 potential TB vaccines being tested in human trials and up to 10 experimental medicines in the TB drug 'pipeline.' Since many drugs fail in late-stage trials, this handful of possibilities is unlikely to be enough," Reuters reports (Kelland, 5/18).

The series also focused on the broader issues that contribute to the spread of TB, the Associated Press reports. "Experts said TB isn't only a medical problem, but is intertwined with poverty, as it spreads widely among people living in overcrowded, dirty places. They said TB programs need to go beyond health and include other sectors like housing, education and transportation," the news service writes. Philip Stevens, a health policy expert at the International Policy Network, said the disease "cannot be tackled in isolation," noting that the focus of control efforts should be on "economic growth, which is outside the control of the U.N." (Cheng, 5/18).

"In the eighth and final paper ... a call to action is made to a wide range of sectors to assist scale-up TB service delivery, research and control. The launch of The Lancet TB Observatory, which will monitor progress on key indicators on an ongoing basis, is also announced," according to a Lancet press release. The Observatory, which is a collaboration between the Lancet, the Stop TB Parternship, the WHO and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, "will assess and monitor" TB research, financing and other information. In a comment discussing the Observatory, Lancet Editor-in-Chief Richard Horton and Executive Editor Pamela Das observe that currently "there is no formal mechanism to assess this information critically and independently. Nor is there any means to hold the various stakeholders in tuberculosis control to account" (5/18).

The series also includes comments about how to scale-up an integrated TB and HIV response, the burden of the disease in women and children and how migration patterns within and between countries contribute to the spread of TB. The Lancet Table of Contents is available here.