Progress in diagnosing multidrug-resistant tuberculosis

20 March 2014 | Geneva - Almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in 2012, yet less than one in 4 of these people was diagnosed, mainly due to a lack of access to quality diagnostic services.

But with an innovative international project, 27 countries are making promising progress in diagnosing MDR-TB, says WHO in the lead-up to World TB Day, 24 March.

The project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, helped to triple the number of MDR-TB cases diagnosed in participating countries.

“Earlier and faster diagnosis of all forms of TB is vital,” says Dr Margaret Chan, WHO Director-General. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.”

World TB Day 2014: Reach the 3 million

"Earlier and faster diagnosis of all forms of TB is vital. It improves the chances of people getting the right treatment and being cured...”

Dr Chan, WHO Director-General

The theme for World TB Day 2014 is “Reach the 3 Million”. One third of the estimated 9 million people falling ill with TB each year do not get the care they need. In many countries, it is hard for people to access diagnostic services – particularly for MDR-TB. Some countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In some cases, patient samples have to be sent to other countries for testing. Moreover, traditional diagnostic tests can take more than 2 months to get results.

But the situation is beginning to change. New technologies can rapidly diagnose TB and drug-resistant TB in as little as two hours.

“The MDR-TB story is being transformed by a fertile mix of collaborators, including those working on access to diagnosis,” says Philippe Meunier, the French Government’s Ambassador for the fight against HIV/AIDS and communicable diseases. “Increased capacity and reduced prices mean more patients can be served, and global health risks would be diminished.”

In 2009, UNITAID provided US$ 87 million to support the EXPAND-TB multi-partner project to enable effective and sustained access, and use of recommended new TB diagnostic technologies in 27 low- and middle-income countries. These countries together carry 40% of the estimated global MDR-TB burden.

The project delivers positive results

The project has delivered impressive results. Over 30% of the MDR-TB cases detected globally in 2012 were from EXPAND-TB countries. 90% of India’s detected MDR-TB cases were through EXPAND-TB supported services. Use of these tests requires strengthened laboratory services. By the end of 2013, 92 laboratories were fully operational. From 2009 to 2013, the number of MDR-TB cases diagnosed in the 27 countries tripled, with 36 000 diagnosed in 2013 alone.

The project has enabled more patients to be treated with quality-assured second-line TB medicines. Through that demand, the project has helped to reduce the price of individual medicines and MDR-TB treatment regimens by one third. Prices have also dropped for diagnostic commodities.

Project partners are WHO and the Global Laboratory Initiative (GLI), the Stop TB Partnership’s Global Drug Facility and FIND. Project funds have been used to purchase testing equipment and commodities, and to train laboratory technicians.

The EXPAND-TB project complements investments in laboratory infrastructure and diagnostic services from international partners, including The Global Fund to Fight AIDS, TB and Malaria, The World Bank and the United States Government.

“The gap in access to TB diagnostics and care is far from filled, but is narrowing. With the impetus of modern laboratories, we are on the right track finally to handle MDR-TB,” says Dr Mario Raviglione, Director of WHO’s Global TB Programme.

Ministries of health are now working on securing domestic funding for the medium-term and working with partners to fill financing shortfalls for quality diagnostic tests and services.

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Note to editors

EXPAND-TB Partners, and additional quotes from participants in the 20 March press briefing

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

UNITAID is a global health initiative launched in 2006 by the Governments of Brazil, Chile, France, Norway and the United Kingdom to provide sustainable funding for the fight against HIV/AIDS, malaria and tuberculosis. About 70% of UNITAID’s funds come from a small levy on airline tickets. Through implementers, UNITAID finances the purchase of quality-assured drugs and diagnostics for patients in poor countries, using its market power to expand supply, promote development of new and better products, cut delivery lead times and reduce prices.

Dr Philippe Duneton, Executive Director a.i., UNITAID said, “The EXPAND-TB project has been an important part of UNITAID’s TB investment portfolio as identifying cases has been, and remains, essential. To reach the missing three million, we must continue to find and use ever-better diagnostics technologies, but also enable access for low- and middle-income countries to the new medicines now available.”

The Stop TB Partnership’s Global Drug Facility (GDF) coordinates and manages procurement and delivery of TB commodities like quality assured medicines, diagnostic equipment and supplies to eligible countries, offering as well technical assistance for building more sustainable supply chain systems. The GDF has procured and distributed diagnostics and laboratory equipment for the project and, by pooling the global demand for Second Line anti-TB Drugs within one single procurement platform, has reached up to 32% cost reduction for MDR-TB treatment, bringing a broader basis of suppliers producing quality assured medicines and allowing more market competition.

“We need to ensure that diagnostics are accessible and closer to people. This project is a successful multi-partner strategic approach where diagnostic, treatment capacity and medicines supply have been linked together, showing the path for a stronger fight against MDR-TB " said Dr Joel Keravec, GDF Special Advisor.

FIND is an international non-profit organization that drives development and delivery of innovative diagnostic solutions for poverty-related diseases. As the main implementing partner for EXPAND-TB, FIND works closely with national TB programmes and multiple international and local partners to build laboratory capacity, accelerate uptake and establish the know-how needed for correct use of new TB technologies. FIND helps ensure that all the key components that are needed for successful diagnostic implementation are put in place, and aims to maximise patient impact.

Dr Catharina Boehme, FIND’s Chief Executive Officer, said “Without diagnostics, medicine is blind. The EXPAND TB project is critical for scaling up the capacity to detect TB drug resistance. It has also laid the ground for rapid uptake and proper use of future diagnostic innovations that are urgently needed to effectively fight TB and drug resistance. Continued commitment from the global health community in support of new tools, especially point-of-care diagnostics, should remain a high priority.”

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For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Tel.: +41 22 791 5099
Email: jasarevict@who.int

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World malaria report 2013 shows major progress in fight against malaria, calls for sustained financing

11 December 2013 | Geneva/Washington DC - Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the "World malaria report 2013" published by WHO.

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the 10 countries with the highest malaria burden, and among children aged less than 5 years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

But more needs to be done.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria (uncertainty interval: 135 – 287 million), which caused approximately 627?000 malaria deaths (uncertainty interval 473?000 – 789?000). An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Long way from universal access to prevention and treatment

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under 5 and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. "Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

Global funding gap

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$ 0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

"The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths," said Fatoumata Nafo-Traore, Executive Director of the Roll Back Malaria Partnership. "This is our historic opportunity to defeat malaria."

Notes for editors:

The "World malaria report 2013" summarizes information received from 102 countries that had on-going malaria transmission during the 2000-2012 period, and other sources, and updates the analyses presented in 2012.

The report contains revised estimates of the number of malaria cases and deaths, which integrate new and updated under-5 mortality estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation, as well as new data from the Child Health Epidemiology Reference Group.

For more information, please contact:

In Geneva
Fadela Chaib
WHO Communications Officer/Spokesperson
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int

In Washington DC
Phil Coticelli
Telephone: +1 301 801 5801
E-mail: phil@coticelligroup.com

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Health research is essential for progress towards universal health coverage

15 August 2013 | Beijing - At the launch of the "World health report 2013: Research for universal health coverage", WHO today called on countries to continue investing in local research in order to develop a system of universal health coverage tailored to each individual country’s situation. With universal health coverage, countries can help ensure that citizens obtain the health services they need without suffering financial hardship when paying for them.

Dr Margaret Chan, Director-General of WHO, describes universal coverage as “the single most powerful concept that public health has to offer.” In launching the "World health report 2013: Research for universal health coverage", Dr Chan says “universal coverage is the best way to cement the health gains made during the previous decade. It is a powerful social equalizer and the ultimate expression of fairness.”

The role of research for universal health coverage

The report shows how countries, when developing a system for universal health coverage, can use research to determine what health issues should be addressed, how a system should be structured and how to measure progress according to their specific health situation.

Universal health coverage is the single most powerful concept that public health has to offer.

Dr Margaret Chan, WHO Director-General

The report reveals that, on average, domestic investment in research in low- and middle-income countries has been growing 5% each year. This trend is most visible in emerging economies such as Brazil, China and India, all of which have embraced the concept of universal health coverage.

Case studies from many countries demonstrate the importance of local and global research for improving health, ranging from the prevention and control of specific diseases to the better functioning of health systems. The results of these studies emphasize the critical need for research to be carried out locally, where researchers can consider specific factors critical to individual countries.

“Research for universal health coverage is not a luxury; rather, it is fundamental to the discovery, development and delivery of interventions that people need to maintain good health,” the report notes.

The growth of health research

The report also shows that more health research is being published as a result of international collaboration. Scientists from low- and middle-income countries are increasingly engaged in these collaborations, although high-income countries continue to play a prominent role in most studies. China is one example: from 2000 to 2010 the global share of Chinese researchers as co-authors on published research increased from 5% to 13%. Brazil, India and other countries have also increased their participation in published research. However, although research is increasing overall, growth is uneven.

“All nations should be producers as well as consumers of research. The creativity and skill of researchers are the backbone of academic and public health programs,” says Dr Christopher Dye, Director, Office of Health Information, HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases and lead author of the report. “A wide range of basic and applied research studies is essential to reach universal health coverage, but gaps between knowledge and action are being closed very slowly. We need to accelerate the process of bringing scientists and decision makers together to improve health service coverage.”

Universal health coverage requires a strong, efficient, well-run health system; a system for financing health services; access to essential medicines and technologies, and sufficient well-trained, motivated health workers.

To meet the challenges, WHO encourages international donors and national governments not only to invest in research, but also to support mechanisms for sharing information and data, to strengthen research training and institutions, and to measure progress against their own commitment to achieving universal health coverage.

For more information please contact:

Helen Yu
Communications Officer
WHO in China
Telephone: +86 10 65327191
Mobile: +86 139 1 1205167
Email: yuji@wpro.who.int

Glenn Thomas
Communications Officer
WHO, Geneva
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

Gregory Hartl
Coordinator
News, Social Media and Monitoring, WHO
Telephone: +41 22 7914458
Mobile: +41 79203 6715
E-mail: hartlg@who.int

View the original article here

Health research is essential for progress towards universal health coverage

15 August 2013 | Beijing - At the launch of the "World health report 2013: Research for universal health coverage", WHO today called on countries to continue investing in local research in order to develop a system of universal health coverage tailored to each individual country’s situation. With universal health coverage, countries can help ensure that citizens obtain the health services they need without suffering financial hardship when paying for them.

Dr Margaret Chan, Director-General of WHO, describes universal coverage as “the single most powerful concept that public health has to offer.” In launching the "World health report 2013: Research for universal health coverage", Dr Chan says “universal coverage is the best way to cement the health gains made during the previous decade. It is a powerful social equalizer and the ultimate expression of fairness.”

The report shows how countries, when developing a system for universal health coverage, can use research to determine what health issues should be addressed, how a system should be structured and how to measure progress according to their specific health situation.

Universal health coverage is the single most powerful concept that public health has to offer.

Dr Margaret Chan, WHO Director-General

The report reveals that, on average, domestic investment in research in low- and middle-income countries has been growing 5% each year. This trend is most visible in emerging economies such as Brazil, China and India, all of which have embraced the concept of universal health coverage.

Case studies from many countries demonstrate the importance of local and global research for improving health, ranging from the prevention and control of specific diseases to the better functioning of health systems. The results of these studies emphasize the critical need for research to be carried out locally, where researchers can consider specific factors critical to individual countries.

“Research for universal health coverage is not a luxury; rather, it is fundamental to the discovery, development and delivery of interventions that people need to maintain good health,” the report notes.

The report also shows that more health research is being published as a result of international collaboration. Scientists from low- and middle-income countries are increasingly engaged in these collaborations, although high-income countries continue to play a prominent role in most studies. China is one example: from 2000 to 2010 the global share of Chinese researchers as co-authors on published research increased from 5% to 13%. Brazil, India and other countries have also increased their participation in published research. However, although research is increasing overall, growth is uneven.

“All nations should be producers as well as consumers of research. The creativity and skill of researchers are the backbone of academic and public health programs,” says Dr Christopher Dye, Director, Office of Health Information, HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases and lead author of the report. “A wide range of basic and applied research studies is essential to reach universal health coverage, but gaps between knowledge and action are being closed very slowly. We need to accelerate the process of bringing scientists and decision makers together to improve health service coverage.”

Universal health coverage requires a strong, efficient, well-run health system; a system for financing health services; access to essential medicines and technologies, and sufficient well-trained, motivated health workers.

To meet the challenges, WHO encourages international donors and national governments not only to invest in research, but also to support mechanisms for sharing information and data, to strengthen research training and institutions, and to measure progress against their own commitment to achieving universal health coverage.

Helen Yu
Communications Officer
WHO in China
Telephone: +86 10 65327191
Mobile: +86 139 1 1205167
Email: yuji@wpro.who.int

Glenn Thomas
Communications Officer
WHO, Geneva
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

Gregory Hartl
Coordinator
News, Social Media and Monitoring, WHO
Telephone: +41 22 7914458
Mobile: +41 79203 6715
E-mail: hartlg@who.int

View the original article here