50% of not good enough is still not good enough – the post-2015 MDG discussion

At the Union World Conference on Lung Health, bureaucrats and activists alike are calling for “bold targets and policies” on tuberculosis.

The World Health Organization (WHO) and Stop TB Partnership hosted a symposium this week at the Union to consult on draft goals and targets related to tuberculosis.

Civil Society Activists at the Union ConferenceThe United Nations is currently consulting with governments, civil society, and others about what kind of framework should replace the Millennium Development Goals (MDGs) - a set of eight internationally agreed-upon goals to end extreme poverty.

The current MDG targets for TB – to halt and reverse new cases of TB by half and to increase case detection and treatment – have been universally recognized as weak. New cases of TB are falling globally a rate of only 2.2% per year – considered “on track” to meet the 2015 goal – yet at this continued rate of decline it would be a century until we see the elimination of TB. This rate also hides TB hot spots in Europe and Africa.

The WHO is proposing a goal of zero TB deaths, which civil society and activists have widely embraced as both aspirational and achievable. But there is a huge disconnect between the “zero goal” and proposed 2025 targets. Using 2015 as a baseline, the draft post-2015 MDGs for TB are:

  • 50% reduction in TB deaths by 2025
  • 50% reduction in new cases of TB
  • A target (to be determined) on multi-drug resistant TB

A couple of problems with these targets:

  • They maintain the status quo. They assume TB rates will decline at only a slightly faster pace than in the previous 25 years. The reality is, we’re getting smarter about TB, and improvement should be faster now – new HIV infections are declining, more people living with HIV are on treatment, and preventive therapy is available to those at high-risk for TB. Further, these targets assume flat donor and domestic funding.
  • They don’t take into account newly available health technologies like the Xpert diagnostic, or new drug regimens and preventive vaccines in the R&D  pipeline
  • Measuring deaths and new infections are the wrong metrics. Numbers of deaths and 'new' infections may actually rise with additional resources for detecting TB. Plus, many countries are now reporting child TB deaths, something they weren’t doing until recently.
  • We must act urgently on drug resistant-TB –antibiotic resistance won’t wait until we’re ready. According to a new report by Doctors without Borders and The Union, a single case of drug resistant TB costs US$5,000 on average, with a 50% cure rate. One case of DR-TB in the US can cost into the $100,000, while TB that can be treated by a commonly used drug costs only a few hundred dollars.
  • Delaying the end of TB hurts economically. TB Alliance estimates the global TB burden will cost $1 to $3 trillion over the next 10 years – not to mention that 75% of TB cases arise during people's most productive years.

So we must BE BOLD. We must be realistic, but ambitious too, so we can push policymakers, donors, health care workers, and community members to try harder than we’ve ever tried before. 

Keeping targets conservative lets us all off the hook, at the expense of the world’s most vulnerable people. The MDGs can harness international attention and resources – this is a huge opportunity to push for real progress towards elimination of this infectious disease.

So let’s give the WHO the political cover they need to be bold, because without hearing from us – the advocates – in a way that’s impossible to ignore, we’re stuck with the status quo.

What do you think – which targets will move us closest to elimination of TB the fastest? More broadly, what do we want to make sure is include in the post-2015 MDGs related to health to eliminate extreme poverty and promote quality of life?