MANILA, 24 October 2013 –While the WHO Western Pacific Region remains on track to achieve Millennium Development Goal 6 concerning halting and reversing tuberculosis incidences by 2015, the World Health Organization Regional Committee for the Western Pacific has urged Member States to consider bold investments and actions to move towards elimination of all forms of the disease.
“The burden of tuberculosis in our Region is still unacceptably high,” says WHO Regional Director for the Western Pacific Dr Shin Young-soo. “We need political commitment, bold investments and actions to sustain our progress.”
Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis that most commonly affects the lungs. It is transmitted from person to person via droplet nuclei (airborne transmission) from the throat and lungs of people with the active respiratory disease. TB tends to concentrate in high-risk and vulnerable populations, such as migrants, the elderly and the poor.
Of the 22 high-burden TB countries that account for more than 80% of the world’s cases, four are in the Western Pacific Region: Cambodia, China, the Philippines and Viet Nam. Together, these four account for 93% of the cases in the Region. Some significant improvements have been achieved over the past 20 years: TB deaths in the Region decreased significantly between 1990 and 2011, as did the number of people falling sick with the disease.
The expansion of Directly Observed Treatment Short-course (DOTS)—the TB control approach launched by WHO in 1995—has proven very successful and cost-effective. The treatment strategy was implemented in all countries in the Region by 2005. This contributed to the achievement of the intermediate TB control targets of 70% case detection, successful treatment of 85% of cases and reaching 100% of the population with DOTS access.
Moreover, TB prevalence surveys, conducted with WHO support, have made estimates more accurate and highlighted both substantial impact of national TB control programmes and the immensity of the remaining burden.
Important challenges remain. In the Region, 1.4 million people are diagnosed with TB annually, and 130 000 people die each year from this curable disease.
Moreover, drug-resistant TB is on the rise in the Region, with an estimated 78 000 multidrug-resistant TB (MDR-TB) patients added annually and increasing numbers of patients with extensively drug-resistant TB (XDR-TB). Furthermore, the MDR-TB epidemic is spreading, posing major financial and technical challenges. WHO analysis shows that the vast majority of MDR-TB is in newly diagnosed TB patients, meaning people are being infected by resistant strains, rather than developing resistance during their treatment.
MDR-TB is TB that does not respond to at least isoniazid and rifampicin, the two most powerful anti-tuberculosis drugs. The primary cause of MDR-TB is suboptimal TB treatment. Most people with tuberculosis are cured by a strictly followed, six-month drug regimen with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs, can cause drug resistance. Strong and enforced regulations to ensure acceptable, effective tuberculosis treatment can help control MDR-TB.
In order to address the many challenges posed by TB, the Regional Strategy to Stop Tuberculosis in the Western Pacific (2011–2015) was developed in consultation with Member States and the WHO Stop TB Technical Advisory Group. The strategy’s goal is to reduce by half the prevalence of and deaths from all forms of TB by 2015 relative to the 2000 level in all high-burden TB countries, by moving towards universal access to diagnosis and treatment of all forms of TB, including smear-negative and M/XDR-TB. The strategy provides a reference for actions to be taken in light of the five core objectives:
§ Promoting universal and equitable access to quality TB diagnosis and treatment for all people.
§ Strengthening TB laboratory capacity.
§ Scaling up the programmatic management of drug-resistant TB.
§ Expanding TB/HIV collaborative activities.
§ Strengthening TB programme management capacity.
All countries with a high TB burden have aligned their national strategic plans with the regional strategy and are making progress towards its targets. WHO has supported this process and delivered technical assistance, with a focus on MDR-TB, surveillance, laboratory strengthening, new tools and new strategies for vulnerable groups, and TB/HIV co-infection. WHO organized several training-of-trainers activities in different fields to build national capacity and reduce dependency on international consultants. In close consultation with countries, WHO is also developing a guidance document on TB control in migrant populations.