Getting to Zero—Join the Movement!

By Colleen Daniels

Tuberculosis (TB), a 40,000-year-old disease, still devastates communities although it has been preventable—and curable—for decades. In 2010, the World Health Organization (WHO) reported 8.8 million TB cases—1.4 million of them fatal—worldwide. TB is the leading cause of death among people living with HIV; in 2010, it claimed 350,000 lives.

TB continues to spread: each year, one-third of all cases—or 3 million people—go undiagnosed and untreated. In 2010, there were 650,000 cases of multidrug-resistant TB (MDR-TB), which is difficult to cure; 9% were extensively drug resistant TB (XDR-TB), which is often incurable.

What is the current strategy for TB, and why is it inadequate?

The WHO’s Stop TB Strategy has been at the forefront of global TB control since its development in 2006. The Stop TB Strategy anchors its targets to those of the Millennium Development Goals, which include to “halt and begin to reverse the incidence of TB by 2015.” The Strategy therefore aims: 1) by 2015, to reduce prevalence and deaths due to TB by 50% from 1990 levels (reduce prevalence to 155 per 100,000 population, and deaths to 14 per 100,000 per year); and, 2) by 2050, to eliminate TB as a public health problem (<1 case per 1 million population).

These targets help frame TB control; yet therein lies the very problem: the world has for too long accepted anemic efforts to merely control TB, rather than truly fight it. Why are we accepting a target of anything less than zero deaths for the next 40 years, for a disease that is both preventable and curable? What if we fall short of these inadequate targets? This is frighteningly likely, given the lack of political will to fight TB. Strikingly, the WHO’s Stop TB Strategy does not even include increasing political will in its six principal components.

Mediocre efforts to reach unambitious targets delay progress in the fight against TB. The nearly 9 million people per year who fall ill with TB, and the 2 billion more who are infected with the TB bacterium and therefore at risk of developing TB disease, cannot wait until 2050 to have their well-being prioritized.

In May 2012, a group of activists, researchers, clinicians, implementers, policy makers, and foundation and government staff working to stop TB met in Cambridge, Massachusetts. During their three-day meeting, the group gave birth to a global TB strategy focused on a new target: zero TB deaths, zero new TB infections, and zero TB suffering and stigma. To this end, they created the Zero Declaration, which has already been signed by 500 institutions and individuals.

The Zero Declaration is founded on three key realities:

1. TB is preventable and curable.
2. The main driver of today’s unnecessary TB deaths, new TB infections, and suffering and stigma is lack of political will.
3. Every country in the world has the potential to reach the goal of zero TB deaths, zero new TB infections, and zero TB suffering and stigma.

The new campaign calls for “global action and a new global attitude in the fight against TB.” Political will is essential for getting to zero; signatories called for a commitment to remedy the “global health and economic disparities that fuel the spread of TB worldwide.” In particular, political will and commitments that span beyond election cycles are needed to:

• Implement universal access to high-quality testing, care, and treatment for TB, since medications that can cure 8.2 million people are already available; and
• Increase investment in TB research and development to discover and develop new diagnostic tools, drugs, and vaccines to eliminate TB; each year, US$2 billion is needed, yet the global contribution is less than a third of the total needed.

Over the next decade, we can transform the TB epidemic. Instead of witnessing millions of unnecessary deaths, and the continuing spread of TB that is resistant to many—or all—current medications, we can get to zero.

Adequate resources will facilitate discovery, development, and implementation of affordable, easy-to-use and accurate point-of-care diagnostics for all forms of TB disease (pulmonary, extrapulmonary, pediatric, and cases in people living with HIV); vaccines to prevent TB (including cases in people living with HIV, which the current vaccine cannot); and shorter, simpler, less toxic drug regimens effective against all types of TB, including XDR-TB.

The Zero Declaration is a call to galvanize people to take action, and to work together to develop a new global plan now, instead of waiting until 2050 to eradicate TB.