Photo: Riccardo Venturi Vision and proposed framework for a Post-2015 TB Elimination Strategy and Targets Consultation on Eliminating the catastrophic economic burden of TB" Universal Health Coverage and Social Protection Opportunities Sao Paulo, Brazil, 29 April 1 May 2013 Dr Mario Raviglione Director, STB/WHO, Geneva, Switzerland
Overview TB burden, response and progress Post-2015 TB Strategy and targets Way Forward
The Global Burden of TB -2011 Estimated number of cases Estimated number of deaths All forms of TB 8.7 million (8.3 9.0 million) 1.4 million* (1.3 1.6 million) HIV-associated TB 1.1 million (13%) (1.0 1.2 million) 430,000 (400,000 460,000) Multidrug-resistant TB Up to 0.5 million Unknown, but probably > 150,000 Source: WHO Global Tuberculosis Report 2012 * Including deaths attributed to HIV/TB
TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes Who is most affected? Poor, crowded & poorly ventilated settings Half a million women and over 65,000 children die of TB each year; 10 million TB orphans Migrants, prisoners, minorities, refugees face risks, discrimination & barriers to care
The global response: Targets, Global Plan, and Stop TB Strategy 1. Pursue high-quality DOTS expansion Goal 6: to have halted by 2015 and begun to reverse the incidence 2. Address TB-HIV, MDR-TB, and needs of the poor and vulnerable 3. Contribute to health system strengthening 2015: 50% reduction in TB prevalence and deaths compared to 1990 2050: elimination (<1 case per million population) 4. Engage all care providers 5. Empower people with TB and communities 6. Enable and promote research
Global Progress Incidence 51 million patients cured, 1995-2011 20 million lives saved since 1995 Mortality 2015 MDG and other international targets on track BUT, TB incidence declining far too slowly, and the poorest often without access or incur catastrophic expenditures
World Health Assembly 2012 Call from Member States At the 65 th World Health Assembly in May 2012, Member States including Brazil, UK, Italy, Swaziland, Saudi Arabia and others, called upon WHO to develop a new post- 2015 TB strategy and targets and present this to Member States at the 67 th World Health Assembly in 2014.
The Process Strategic & Technical Advisory Group for TB (STAG-TB) Regional Consultations London, Sao Paulo, Cairo, Nairobi, Phnom Penh and Yogyakarta HBC consultation and symposium at World TB Congress in Kuala Lumpur WHO/ Partnership consultation on post- 2015 targets June 2012 June- December 2012 November 2012 January 2013
Process Ahead Pillar 2 Consultation: Universal Health Coverage and Social Protection Opportunities Pillar 3 consultation on research and innovation, and STAG-TB, 2013 WHO Executive Board World Health Assembly 2014 April 2013 June 2013 January 2014 May 2014
The TB Elimination Strategy VISION A WORLD FREE OF TB TOWARDS ZERO TB DEATHS ZERO TB CASES ZERO TB SUFFERING
Targets for 2025/2030 Target 1 Target 2 Target 3 75%/80% reduction in deaths due to TB (compared with 2015) 40%/60% reduction in TB incidence rate (compared with 2015) No catastrophic expenditures for families affected by TB
Proposed Pillars and Principles of the Post-2015 TB Strategy Universal highquality TB care and prevention Bold policies and supportive systems Intensified research and innovation
Three pillars of the TB Elimination Strategy Universal highquality TB Rapid diagnosis of TB including universal care and drug susceptibility prevention testing; systematic screening of contacts and high-risk groups Bold policies and supportive systems 1 2 Intensified Treatment research of all people with and TB including drug-resistant innovation TB, with support Preventive treatment of persons at high-risk and vaccination of children 4 3 Collaborative TB/HIV activities and management of co-morbidities
Three pillars of the TB Elimination Strategy Political commitment with adequate resources for TB care and prevention Bold policies and supportive 1 2 systems Engagement of communities, civil society organizations, and public and private care providers Social protection, poverty alleviation and actions on other determinants of TB 4 3 Universal Health Coverage and regulatory framework for case notification, vital registration, drug quality and rational use, and infection control
Three pillars of the TB Elimination Strategy Discovery, development and rapid uptake of new diagnostics, drugs and vaccines 1 Intensified research and innovation 2 Operational research to optimize implementation and adopt innovations
Rebalancing leadership in generating evidence and developing policy Leadership, resources, and capacity to define needs, generate evidence and innovate is growing rapidly in BRICS and emerging economies WHO policy guidance is developed through leveraging new energy and partnering with countries to enable adaptation and assess impact
Ensuring country relevance and adaptation Adaptation of global strategy informed by assessment of health system challenges and opportunities, mapping epidemics and vulnerable populations, engaging communities Adaptation and formulation of policies starts and ends in countries
Harnessing the power of today's greater focus on: Social and economic determinants of ill health Equity and elimination of extreme poverty Universal Health Coverage and Social Protection
Muito obrigado! Acknowledgements: Monica Dias, Knut Lönnroth, Diana Weil, Mukund Uplekar and all my colleagues at WHO