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Global health organisations have issued a call to action for World Tuberculosis Day, with experts saying the deadly disease can only be eradicated if research funding is ramped up.

TB, a serious disease affecting the lungs, is the biggest infectious killer of our time, causing more than 1.6 million deaths each year. While it is curable with antibiotics, multidrug resistant forms of TB pose an increasing challenge in the battle to combat the disease.

Declines in TB mortality are failing to keep pace with those from other infectious diseases such as HIV and malaria and the world is not on track to meet UN and WHO targets, according to a report in The Lancet medical journal.

“We commemorate World TB Day this year with an urgent call to action, because we cannot lose this unique moment,”

Tereza Kasaeva, director WHO’s global tuberculosis programme

The UN’s Sustainable Development Goals aim to end the epidemics of AIDS, tuberculosis and malaria by 2030, while the WHO targets a 95 per cent reduction in TB mortality and a 90 per cent reduction in TB incidence worldwide by 2035.

Global research investment must increase by four times to eradicate the disease, which affects around a quarter of the world’s population, by 2045, the Lancet report says.

The WHO issued new guidance to improve treatment of multidrug resistant TB, recommending an oral drug regimen which it says is more effective and has fewer adverse side-effects than current injectable drug treatments.

The theme of this year’s World TB Day, on March 24, is “It’s time to end TB”. Tereza Kasaeva, director of the WHO’s global tuberculosis programme, said while the WHO’s goals on eradicating TB were “ambitious”, they were also “achievable and realistic”.

“We commemorate World TB Day this year with an urgent call to action, because we cannot lose this unique moment,” she told SciDev.Net. “We have made very important commitments, now it is time to translate those commitments into concrete action.”

The first-ever UN High-Level Meeting on TB in 2018 set ambitious goals to treat 40 million people and to prevent 30 million new cases between 2018 and 2022.

Kasaeva said research must now focus on prevention, especially for the under-fives and people living with HIV, who are particularly vulnerable to the disease.

Global spending on tuberculosis research reached US$726 million in 2016, but the Lancet Commission on TB, compiled by experts from 13 countries, says much more is needed to develop new ways to diagnose, treat, and prevent the disease.

Even if current treatments were extended to 90 per cent of people with TB, and 90 per cent were successfully cured, existing efforts would have failed to avert 800,000 deaths in 2017, the report stated.

Investment also carries economic gains, the commission highlighted, with savings from averting a TB deaths estimated to be three times the cost, or even higher in so-called “high-burden countries”.

Making high-quality diagnostic tests and treatments available to all, including in the poorest countries, should be the top priority, the report said.

Report co-author Michael Reid, of the University of California San Francisco, USA, said TB was “a solvable problem”.

“We have rapid, sensitive diagnostic tools, and the promise of potent TB treatment strategies in the pipeline,” he said. “In addition, TB control strategies, new health technologies … and growing political momentum could all make ending TB within a generation more feasible than ever before.”

Mel Spigelman, head of the US-based TB Alliance, told SciDev.Net that eradication was achievable “with the right combination of sustained funding and political will”.

“That starts with closing the funding gaps for treatment and research as governments signalled they would at last year's UNGA high-level meeting on TB,” he said. “True follow-through is needed, especially from the high-burden countries that increasingly have the resources to make investments in research and development.”

According to estimates in The Lancet commission, Bangladesh, Zambia, China, and Indonesia have the capacity to increase their annual TB expenditures by more than five-fold over the next five years. Spigelman said research needed to focus onone or more vaccines” and improved diagnostics to help identify the “missing millions” who remain undiagnosed, as well as safer, more effective, and affordable treatments.

The BCG vaccine is partially effective at protecting infants and young children, but is less effective at protecting adults from pulmonary TB. Several new vaccines are currently under development.

He welcomed the WHO guidelines on oral drugs as an alternative to injectable TB treatments which he said can be “intolerable and debilitating”, but warned that the 18 to 20-month course of treatment carried cost and compliance implications.

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