Technical Advisory Group meeting, WHO/WPRO The End TB Strategy Role of WHO in supporting implementation of the new global strategy Philippe Glaziou, on behalf of Mario RAVIGLIONE, Director Technical Advisory Group meeting, WHO/WPRO Manila 9-12 December 2014

Global Burden of TB in 2013 1.5 million 9 million 480,000 Estimated number of cases Estimated number of deaths 1.5 million 80,000 in children 510,000 in women 9 million 126 per 100,000 550,000 in children 3.3 m in women 480,000 All forms of TB Multidrug-resistant TB HIV-associated TB 1.1 million (13%) 360,000 210,000

TB cases and deaths, 1990–2013 9 million incident cases in 2013 5.7 million reported to WHO 1.5 million deaths in 2013 All cases HIV-negative HIV-positive cases 1.1m HIV-positive

480,000 MDR-TB, 9% with XDR Highest % in the former USSR countries India, China, Russia, Pakistan and Ukraine have 60% of all MDR-TB cases

Accelerated MDR detection, but widening treatment gap 136,000 detected (2013) Accelerated MDR detection, but widening treatment gap 97,000 treated (2013)

48% MDR treatment success globally

MDR-TB: Five priority actions

78% of TB/HIV cases in Africa Response to TB/HIV means cutting transmission and mortality 78% of TB/HIV cases in Africa Other co-morbidities emerging in other regions

48% global HIV testing coverage, 76% in Africa

Intensifying research The needs are clear: Understand pathogenesis & immunity PoC diagnostic tests Short regimens incl. for LTBI Post-exposure vaccine Epidemiological, health system, implementation research

Funding gap US$ 8 billion per year required for the response US$ 2 billion gap US$ 2 billion required for R&D Cost per case US$ 100-500 Cost per MDR case US$ 9,000-49,000

Global progress on impact - 2014 TARGETS ON TRACK Reduction in TB mortality rate of 45% since 1990 37 million lives saved since 2000 86% cure rate and 61 million patients cured, 1995-2013 BUT…. incidence falling too slowly at 1.5%/year

Challenges: 5 priorities for action 5 PRIORITIES TO ELIMINATE TB Reaching the “missed” cases (3 million not in the system) Address MDR-TB as crisis Accelerate response to TB/HIV Increase financing to close resource gaps Intensify research and ensure rapid uptake of innovations

67th World Health Assembly, Geneva, May 2014

Global projections to 2035

The End TB Strategy: Vision, goal, targets Vision: A world free of TB Zero TB deaths, Zero TB disease, and Zero TB suffering Goal: End the Global TB epidemic (<10 cases per 100,000) Target 1 95% reduction in deaths due to TB (compared with 2015) Target 2 90% reduction in TB incidence rate (compared with 2015) Target 3 No affected families face catastrophic costs due to TB

3 pillars and 4 Principles Bold policies and supportive systems Integrated, patient-centered TB care and prevention Intensified research and innovation Government stewardship and accountability, with monitoring and evaluation Building a strong coalition with civil society and communities Protecting and promoting human rights, ethics and equity Adaptation of the strategy and targets at country level, with global collaboration

The End TB Strategy components 1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION Early diagnosis, universal DST, screening of contacts and high-risk groups Treatment of all, including DR-TB, patient support Collaborative TB/HIV activities, management of co-morbidities Preventive treatment of persons at high risk, vaccination against tuberculosis 2. BOLD POLICIES AND SUPPORTIVE SYSTEMS Political commitment, adequate resources for tuberculosis care and prevention Engagement of communities, civil society, and public and private care providers Universal health coverage policy, regulatory frameworks for notification, vital registration, rational use of medicines, infection control Social protection, poverty alleviation and actions on other determinants of TB 3. INTENSIFIED RESEARCH AND INNOVATION Discovery, development, rapid uptake of new tools Research to optimize implementation, impact - promote innovations

“Global Consultation Towards Elimination of Tuberculosis in Countries with Low Incidence of Disease” Rome, 4-5 July 2014 Countries with < 10/100,000 TB cases/year, notified all forms cases & > 300k population Other countries progressing rapidly or with potential to consider elimination in the future

Targets for low-incidence countries <100 cases per million Current TB burden-2012 in low-incidence countries   <10 cases per million Pre-elimination: 2035 in low-incidence countries   <1 case per million Elimination: 2050  

Way forward: What will WHO do globally? Norms, strategies and policies Global M&E for impact and progress Adaptation towards elimination in low-incidence countries Support ROs' efforts in adopting & adapting Guidance on adoption and adaptation of the new strategy Access to innovations Focus on the most vulnerable populations Multi-sectoral partnerships for social protection Promotion of research and innovation Advocacy and promotion of the new strategy Investment plan with partners for resource mobilization Investment plan

What will WHO do in countries? Technical assistance to adapt, plan, and implement the new strategy with focus on: Vulnerable communities Missed cases, TB/HIV and MDR-TB Monitoring & evaluation Research, application of innovations Social development Support in resource mobilization Partnership with GF on TA for epidemiological assessment, programme reviews, NSP, and concept note development Partnership with UNITAID to strengthen diagnostic capacity and access to new/essential commodities Close collaboration with other international donors

Conclusions Global achievements also depend on success in the regions, especially WPR, with nearly 20% of the global burden Reaching the 2025 and 2035 targets in WPR requires… In middle- and high-incidence countries: full adoption, financing and implementation of the new End TB Strategy; In low-incidence countries, TB Elimination Action Framework, intensified support to higher-incidence countries WHO’s Global TB Programme committed to support all efforts by countries in WPR and by WHO/WPRO to make TB elimination a reality