NEW YORK/HAMBURG/GENEVA, JULY 5, 2017—Two days ahead of the G20 summit in Germany, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) and the Stop TB Partnership released a report that shows countries are lagging behind in tackling tuberculosis (TB), introducing the best diagnostic devices, and implementing globally-recommended policies. The third edition of the “Out of Step” report reviews TB policies and practices in 29 countries–which account for 82 percent of the global TB burden–and shows that countries can do much more to prevent, diagnose, and treat people affected by TB.
Although TB is preventable and treatable, it remains the world's deadliest infectious disease, killing 1.8 million people in 2015 alone. During the same year, the majority (54 percent) of the 10.4 million people with TB lived in the countries represented at the G20 summit. Despite its deadly toll, most countries lag behind in implementing the new medicines and diagnostic tools available to tackle TB.
The G20 governments are major contributors to the global TB response, contributing more than $1.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2016. These leaders must now mobilize their resources to get more people diagnosed, make effective treatments accessible to all people affected by TB, and reduce TB deaths.
“TB is an ancient killer, but we have the knowledge and the tools to tackle this disease; many countries are just not making use of these advances, and people are dying as a result,” said Lucica Ditiu, executive director of the Stop TB Partnership. “We’re calling on the G20 leaders to wake up and do something to stop the unnecessary deaths and the spread of TB, including drug-resistant TB.”
One of the major problems in the global TB response is that countries are not investing in tools to diagnose people in the first place. Only seven countries in the report have made Xpert MTB/RIF—a rapid molecular test to diagnose TB and test for resistance to first-line TB drugs—widely available. This means that the majority of people in the 29 countries surveyed are still tested with a method that fails to detect many cases, or that requires a wait of up to several months to confirm the disease. This challenge explains why so many people remain undiagnosed and untreated; globally in 2015, based on the gap between estimated TB incidence and the actual number of cases reported, 4.3 million people with TB were never diagnosed.
“How are people supposed to get treated for TB when they’re not even getting diagnosed?” asked Dr. Isaac Chikwanha, HIV and TB medical advisor at MSF’s Access Campaign. “If countries don’t do more to make sure that people can be tested, it will be impossible to reduce preventable deaths from TB.”
For those who are diagnosed, some progress has been made to make newer, more effective treatment options and care available to ease the burden of living with TB.
For example, newer medicines for the treatment of DR-TB have demonstrated better outcomes than today’s regimens, which offer only a 28-percent cure rate for extremely drug-resistant (XDR) TB and a 52-percent cure rate for multidrug-resistant (MDR) TB. Seventy-nine percent of countries surveyed include the newer drug bedaquiline in their national guidelines, and 62 percent include delamanid in their guidelines. However, globally, only five percent of people who could have benefitted had access to these drugs in 2016.
Additionally, hospitalization for an extended period of time can limit the ability of a person to have a normal life and should be reserved only for the sickest DR-TB patients. The report found that 34 percent of the countries surveyed still require long-term hospitalization for treatment of DR-TB, which can fuel the spread of TB and increase rates of drug-resistance.
DR-TB treatment, which in some cases requires swallowing nearly 15,000 pills over up to a two-year period, can now be shortened to nine months. Shorter treatments help people to get back to a normal and productive life faster. However, only 13 of the countries surveyed (45 percent) have made shorter treatments available.
“With TB, the clock is ticking rapidly, as every 18 seconds a person dies of TB. We have to change that,” said Sharonann Lynch, HIV and TB policy advisor at MSF’s Access Campaign. “The number of people diagnosed over the last four years has stalled, while the number of deaths has increased rather than decreased. Countries need to use new tools and step up the pace of their response.”
 Armenia, Afghanistan, Bangladesh, Belarus, Brazil, Cambodia, Central African Republic (CAR), China, Democratic Republic of Congo (DRC), Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Mozambique, Myanmar, Nigeria, Pakistan, Papua New Guinea (PNG), Philippines, Russian Federation, South Africa, Swaziland, Tajikistan, Viet Nam, Ukraine and Zimbabwe.
 Armenia, Belarus, Brazil, Georgia, South Africa, Swaziland, and Zimbabwe.
 Afghanistan, Bangladesh, Cambodia, CAR, DRC, Kyrgyzstan, Myanmar, PNG, Philippines, Swaziland, Tajikistan, Viet Nam and Zimbabwe.
MSF is an independent international medical humanitarian organization that delivers medical care to people affected by armed conflicts, epidemics, natural disasters, and exclusion from health care. Founded in 1971, MSF has operations in over 60 countries today. MSF has been treating people with TB for 30 years. In 2016, MSF treated more than 20,000 people with TB, including 2,700 people with multi-drug-resistant TB (MDR-TB). The Stop TB Partnership and its 1,600 partners are a collective force that is transforming the fight against TB in more than 110 countries.