Wiping out TB by 2045 could cost up to $10bn a year

Tuberculosis - a disease that has been around for thousands of years - could be wiped out by 2045 if investment in the disease is increased to $10billion a year.

A panel of experts has set out a vision for ending TB within the next 25 years if the world invests in a range of measures including research and development, targeted prevention and high quality diagnostics.

The Lancet Commission on TB, published ahead of World TB Day on March 24, says that the savings generated from averting a TB death are estimated to be three times the cost and could be much greater in many countries where the disease is most prevalent.

TB is the world’s leading infectious killer, responsible for 1.6 million deaths worldwide in 2017, with drug-resistant forms of the disease threatening control efforts in many parts of the world. Progress on fighting the disease has stalled in recent years.

The World Health Organization (WHO) first declared TB a public health crisis in 1993, and last year the first-ever UN High-Level Meeting on TB made ending the disease a global priority.

Countries committed to treating 40 million people and preventing 30 million new cases between 2018-2022. However, many experts say the world is not on track to achieve this.

The commission was timed to launch six months after the meeting as a way of building momentum on the commitments made there, said Mike Reid, co-author of the report.

"Despite the huge amount of political will shown at the meeting countries still haven't ponied up in terms of investing where they said they would," said Dr Reid, assistant professor of global health University of California San Francisco.

Nick Herbert MP, chair of the All Party Parliamentary Group on TB and one of the commission’s authors, said: “Countries need to be held to account for the commitments they have already made, including at the UN high level meeting.

"That was a tremendous declaration - but the clock is ticking on the commitment to find and treat 40 million people by 2022.”

In its vision for wiping out the disease the commission urged countries to invest in high-quality rapid diagnostics; target those at high risk of contracting TB, such as those living with patients infected with the disease; and increase investment in research and development, particularly vaccines and diagnostics.

It says that the 10 countries with the highest burden of the disease need to implement specific measures to make a significant dent in rates of the disease.

India, for example, could avert eight millions deaths between now and 2045 if care and treatment of patients with TB is improved. In Moldova, where more than 25 per cent of all TB cases are drug resistant, improving access to drug susceptibility testing and second-line drugs would reduce mortality by 44 per cent.

But the commission says that while TB-specific measures are important, improving access to essential health services would also go a long way towards wiping out the disease.

Investment is a crucial part of the picture, says the report. Currently $772m a year is invested in TB research but that needs to be increased to at least $2bn a year over the next four years.

The initial global costs to reduce TB deaths by 90 per cent (from 1.7 million per year to less than 200,000 a year) could be $10 billion a year. However, costs would go down to $1-2 billion a year by the early 2040s as the number of new cases falls.

The commission estimates that investing in TB has a strong return on investment, with an estimated $16-82 return for every dollar spent on TB research and development.

Last year a landmark study of a vaccine developed by British pharmaceutical giant GSK and non profit the International Aids Vaccine Initiative showed promise as it reduced TB rates by about half. But the vaccine is still in the early stages of development.

Dr Reid said the new vaccine and new drugs such as bedaquiline and delamanid meant there was significant grounds for optimism. But he added good tools already exist.

"Existing efforts fail to identify 35 per cent of the burden of TB but we have diagnostics and treatments that could be readily available if only countries committed to investing in services to diagnose and treat," he said.

Dr Reid said that it was largely countries most affected by TB who should be making the investments, rather than international donors.

"Many of these high-burden countries such as India could substantially increase their investment in TB by prioritising their health systems and increasing their tax revenue by taxing things like tobacco. Some countries could increase the revenue generated five fold," he said.

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