The fight to end tuberculosis: a global challenge in strong partnership.

Since 1982, one century after the discovery of Mycobacterium tuberculosis as the causal agent of the disease by Robert Koch in Berlin, on March 24th each year the World Health Organization (WHO) celebrates the World TB day.

This event aims to raise people awareness about the burden of tuberculosis (TB) and the status of TB prevention and to spur social and political stakeholders to make further efforts and work together in strong partnerships to stop TB at all levels [1].

The global end TB strategy 2016-2035 and the WHO global TB programme develop policies, strategies and standards, assess national programme performances and facilitate partnerships and communication to advance universal access to TB prevention, care and control.

The global TB report 2019 showed that the world didn’t reach 2019 goal in stop TB, and that multidrug resistant TB is still spread in many countries in the world.

TB is one of the top 10 causes of death worldwide, killing over 4.500 people every day [2]. In 2018, there were an estimated 10 million new TB cases worldwide.

There were an estimated 1.2 million TB deaths among HIV-negative people in 2018, and an additional 251.000 among HIV-positive people; 57% of all TB cases were in men in 2018.

Geographically, most TB cases in 2018 were in the WHO Regions of South-East Asia (44%), Africa (24%) and the Western Pacific (18%) [2].

Moreover, the social and economic impacts of tuberculosis worldwide are devastating, including poverty, stigma and discrimination.

On 26 september 2018, the first hig-level meeting of the United Nations General Assembly (UNHLM) on the fight against tuberculosis brought together Heads of State under the theme “United to end tuberculosis: an urgent global response to a global epidemic”, with support of WHO and other international organizations.

The meeting resulted in an action-oriented political declaration, builds on previous commitments in the Moscow declaration to End TB, that will strenghten action and investments towards the end TB response [3].

The end TB strategy adopted by the WHO in 2014 aims to end the global TB epidemic and to remove catastrophic costs for TB-affected households by 2030, to reduce deaths about 90% and TB incidence of 80%.

The 2020 theme for stop TB day, “It’s time!”, highlights the timely need for action in scale up, research, funding, human rights and accountability [4].

Main goals are:

improve access to prevention and treatment of tuberculosis;

grant for research;

stop discrimination of illness people.

In 2018, 484.000 people developed a drug-resistant tuberculosis; in these cases treatment success rate was low globally, with a mean of 56% [2].

Drug resistant TB remains a public health problem with gaps in detection and treatment: in 2016 490.000 people developed a multi-drug resistant TB worldwide, and other 110.000 people were affected by rifampicin-resistant TB and required second-line treatment [5].

From 2000 to 2016, however, about 53 million people were saved, also thanks to a great effort organized and carried out worldwide, that permitted to reduce the mortality rate by 42%.

Every year, during the World TB Day, WHO together with the Global Fund and Stop TB Partnership highlights to governments, communities, civil society organizations, health care providers and national / international partners the need to join forces under the slogan “Find. Treat. All. #EndTB” to guarantee assistance to millions of people who do not have access to quality care.

United Nations member states committed to fulfilling the following key targets by 2022: successfully treat 40 million people with TB, including 3.5 million children (under 15 years of age), successfully treat 1.5 million people with multidrug-resistant TB, including 115.000 children, provide TB preventive therapy for at least 30 million people, including 4 million children under the age of 5, 20 million other household contacts of people affected by TB, and 6 million people living with HIV [6].

Moreover, stakeholders will try to increase global investment in TB prevention, diagnosis, treatment and care to US$ 13 billion annually [4].

A strong support for research, innovation and development is needed by 2025, in order to reach an annual decline in the global TB incidence rate of 17% per year.

Principal targets are to discover a vaccine to lower the risk of infection, or new drug treatment to cut the risk of TB disease in the 1.7 billion people already latently infected [2].

Only by reinforcing a joint response, it is possible for the world to reach the commitments established by the End TB strategy, WHO and Stop TB Global Plan.