But the million dollar question is how do we achieve this when currently the global annual rate of decline of TB incidence is a mere 2%?
Dr Raviglione is optimistic that it is very much possible to achieve 10% decline by 2025. "To eliminate TB (less than 1 case per million) by 2050, TB incidence will have to go down annually by 20% - that is we have to accelerate it by more than 10 times as compared to the current rate. WHO has taken 2035 as the deadline to bring TB incidence down globally to the same level as it is today (in 2015) in the low incidence countries (less than 10 per 100000). It envisages a step by step plan - in the first decade, from 2015 to 2025, accelerate reduction by 1% every year to bring TB incidence down by 10% at the end of 2025. Achieving the 10% decline rate is very much feasible as it is actually what had been achieved in Western Europe in the 1960s and 1970s mainly through social protection and universal coverage for diagnosis and treatment. If countries like Netherlands did that in 1970s, why cannot growing economies such as China, India etc do it now? So with the current tools (GeneXpert, Line Probe assays, for instance), that are obviously better than what was available in 1970s we can achieve this 10% annual reduction in TB incidence. If in the next 10 years we push for research to give us new tools - a cheap point of care diagnostic test, a vaccine new drugs and shorter treatment regimens for active TB and and a new prophylaxis that can be given safely for latent TB infection - then by the end of the second decade (end of 2035) we should be able to achieve a 17% decline - the maximum that has ever been recorded anywhere in small populations like the Eskimos," he said.
Dr Raviglione also spoke about the changing paradigms in the realm of TB care and control as the era of MDGs comes to an end, making way for the SDGs: "From halting TB to ending TB and ultimately eliminating it; placing at the centre all people vulnerable to or affected by TB; translating quest for equity and social justice, through universal health coverage and social protection; rapid introduction of innovations such as new tools, policies and systems; and, above all, the 'all of society' and not just 'all of government' approach to end TB."
Low TB incidence countries in the Asia Pacific region, like Australia (12,000-13,000 TB cases per year with an incidence of 5.6 per 100,000 people) have an important role to play too in controlling TB, feels Dr Raviglione. "Australia should aim to eliminate TB from the country altogether by focussing more on high risk groups like immigrant population - by not only testing them but also giving them prophylaxis - and also work internationally for control of the disease and in research."
Dr Raviglione also made a point about the benefit of investing in TB control as currently the gain is $30 for every $1dollar spent on TB control, which is likely to rise to a return of $43 for every $1 spent once the 2035 targets are met. So governments will have to rise to the occasion and take appropriate action by making available necessary funds and show the political will to incorporate the new tools, including universal access to services and social protection, in their national TB control programmes. Only then will we be able realize the dream of a TB free world.
Shobha Shukla, Citizen News Service - CNS
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