The End TB Strategy Role of WHO in supporting implementation of the new global strategy Philippe Glaziou, on behalf of Mario RAVIGLIONE, Director Technical Advisory Group meeting, WHO/WPRO Manila 9-12 December 2014

Global Burden of TB in 2013

All forms of TB HIV-associated TB Multidrug-resistant TB Estimated number of cases

9 million • 126 per 100,000 • 550,000 in children 3.3 m in women 1.1 million (13%)

480,000 Estimated number of deaths

1.5 million • 80,000 in children • 510,000 in women

360,000 210,000

TB cases and deaths, 1990 –2013

9 million incident cases in 2013 5.7 million reported to WHO 1.5 million deaths in 2013

All cases HIV-negative HIV-positive cases 1.1m

HIV-positive

480,000 MDR-TB, 9% with XDR

Highest % in the former USSR countries India, China, Russia, Pakistan and Ukraine have 60% of all MDR-TB cases

136,000 detected (2013) 97,000 treated (2013) Accelerated MDR detection, but widening treatment gap

48% MDR treatment success globally

MDR-TB: Five priority actions

Response to TB/HIV means cutting transmission and mortality

78% of TB/HIV cases in Africa

Other co-morbidities emerging in other regions

48% global HIV testing coverage, 76% in Africa

Intensifying research

• • • • • The needs are clear: Understand pathogenesis & immunity PoC diagnostic tests Short regimens incl. for LTBI Post-exposure vaccine Epidemiological, health system, implementation research

Funding gap

• US$ 8 billion per year required for the response – US$ 2 billion gap • US$ 2 billion required for R&D • Cost per case US$ 100-500 • Cost per MDR case US$ 9,000-49,000

Global progress on impact - 2014

TARGETS ON TRACK Reduction in TB mortality rate of 45% since 1990 37 million lives saved since 2000 86% cure rate and 61 million patients cured, 1995-2013 BUT….

incidence falling too slowly at 1.5%/year

Challenges: 5 priorities for action

5 PRIORITIES TO ELIMINATE TB 1.

Reaching the “missed” cases (3 million not in the system) 2.

Address MDR-TB as crisis 3.

Accelerate response to TB/HIV 4.

Increase financing to close resource gaps 5.

Intensify research and ensure rapid uptake of innovations

67 th World Health Assembly, Geneva, May 2014

Global projections to 2035

The End TB Strategy: Vision, goal, targets

Vision: A world free of TB

Zero TB deaths, Zero TB disease, and Zero TB suffering

Goal: End the Global TB epidemic (<10 cases per 100,000) Target 1 Target 2 Target 3 95% reduction in deaths due to TB (compared with 2015) 90% reduction in TB incidence rate (compared with 2015) No affected families face catastrophic costs due to TB

3 pillars and 4 Principles

Integrated, patient centered TB care and prevention Bold policies and supportive systems Intensified research and innovation

The End TB Strategy components

1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION A. Early diagnosis, universal DST, screening of contacts and high-risk groups B. Treatment of all, including DR-TB, patient support C. Collaborative TB/HIV activities, management of co-morbidities D. Preventive treatment of persons at high risk, vaccination against tu berculosis 2. BOLD POLICIES AND SUPPORTIVE SYSTEMS A. Political commitment, adequate resources for tuberculosis care and prevention B. Engagement of communities, civil society, and public and private care providers C. Universal health coverage policy, regulatory frameworks for notification, vital registration, rational use of medicines, infection control D. Social protection, poverty alleviation and actions on other determinants of TB 3. INTENSIFIED RESEARCH AND INNOVATION A. Discovery, development, rapid uptake of new tools B. Research to optimize implementation, impact - promote innovations

“Global Consultation Towards Elimination of Tuberculosis in Countries with Low Incidence of Disease”

Rome, 4-5 July 2014 Countries with < 10/100,000 TB cases/year, notified all forms cases & > 300k population Other countries progressing rapidly or with potential to consider elimination in the future

Targets for low-incidence countries <100 cases per million Current TB burden-2012 in low-incidence countries <10 cases per million <1 case per million Elimination: 2050 Pre-elimination: 2035 in low-incidence countries

Way forward: What will WHO do globally?

Guidance on adoption and adaptation of the new strategy Advocacy and promotion of the new strategy

• Norms, strategies and policies • Global M&E for impact and progress • Adaptation towards elimination in low incidence countries • Support ROs' efforts in adopting & adapting • Access to innovations • Focus on the most vulnerable populations • Multi-sectoral partnerships for social protection • Promotion of research and innovation

Investment plan

• Investment plan with partners for resource mobilization

What will WHO do in countries?

• • • • •

1. Technical assistance to adapt, plan, and implement the new strategy with focus on:

Vulnerable communities Missed cases, TB/HIV and MDR-TB Monitoring & evaluation Research, application of innovations Social development • • •

2. Support in resource mobilization

Partnership with GF on TA for epidemiological assessment, programme reviews, NSP, and concept note development Partnership with UNITAID to strengthen diagnostic capacity and access to new/essential commodities Close collaboration with other international donors

Conclusions

1. Global achievements also depend on success in the regions, especially WPR, with nearly 20% of the global burden 2. Reaching the 2025 and 2035 targets in WPR requires…

• In middle- and high-incidence countries: full adoption, financing and implementation of the new End TB Strategy; • In low-incidence countries, TB Elimination Action Framework, intensified support to higher-incidence countries

3. WHO’s Global TB Programme committed to support all efforts by countries in WPR and by WHO/WPRO to make TB elimination a reality