TBThe World Health Organization (WHO) and the European Respiratory Society (ERS) have launched a new framework to eliminate tuberculosis (TB) in countries with low levels of the disease at the ERS’ International Congress in Munich.

>More than 30 countries and territories report less than 100 TB cases per million population. Representatives from these countries signed up to the framework and its implementation at a meeting in July, co-hosted by WHO and the ERS in Rome in collaboration with the Italian Ministry of Health.

The framework outlines an initial “pre-elimination” phase, aiming to have fewer than 10 new TB cases per million people per year by 2035 in these countries. The goal is to then achieve full elimination of TB by 2050. Elimination is defined as less than 1 case per million people per year.

Although TB is preventable and curable, in these low-incidence settings 155,000 people still fall ill each year and 10,000 die. Millions are infected and at risk of falling ill.

The framework builds on approaches that are already proving successful. It was developed with experts from low-burden countries and adapted from the new WHO global TB strategy, “EndTB”, for 2016-35, approved by the World Health Assembly in May.

“These countries recognize the common need to reenergize efforts to eliminate TB as a public health problem and prevent its resurgence. They already have the means to drive down TB cases significantly by 2035 and can serve as global trailblazers,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “As TB rates have fallen in many of these countries, attention to this public health threat has waned and capacity to respond could be weakened. The key is to target smart TB interventions towards the people who need them most.”

The new WHO framework highlights the effectiveness of eight key interventions, in a coherent package for impact in the target countries:

  • Ensure political commitment, funding and stewardship for planning and essential services of high quality
  • Address the most vulnerable and hard-to-reach groups
  • Address special needs of migrants and cross-border issues
  • Undertake screening for active TB and latent TB infection in TB contacts and selected high-risk groups, and provide appropriate treatment
  • Optimize the prevention and care of drug-resistant TB
  • Ensure continued surveillance, programme monitoring and evaluation, and case-based data management
  • Invest in research and new tools
  • Support global TB prevention, care and control.

Among the most vulnerable groups are people who are poor or homeless, migrants and members of ethnic minorities. In addition, people who use drugs or are incarcerated, and people with compromised immune systems – e.g. people living with HIV, malnutrition, diabetes, smokers and heavy drinkers – all have a much greater risk of falling ill with TB. Many of these vulnerable groups face barriers in accessing health services.

The countries signing up to the framework are: Australia, Austria, Bahamas, Belgium, Canada, Costa Rica, Cuba, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Jamaica, Jordan, Luxembourg, Malta, Netherlands, New Zealand, Norway, Puerto Rico, Slovakia, Slovenia, Sweden, Switzerland, United Arab Emirates, United States of America, West Bank and Gaza Strip.