Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis

The 2019 Lancet Commission on Tuberculosis laid out an optimistic vision for how to build a tuberculosis-free world through smart investments based on sound science and shared responsibility. 1 Reid MJA Arinaminpathy N Bloom A et al. Building a tuberculosis-free world: The Lancet Commission on tuberculosis. Lancet. 2019; 393: 1331-1384 Summary Full Text Full Text PDF PubMed Scopus (204) Google Scholar Since then, several major strides have been made towards ending tuberculosis, including substantive improvements in treatment outcomes for people with drug-resistant disease. 2 Ndjeka N Campbell JR Meintjes G et al. Treatment outcomes 24 months after initiating short, all-oral bedaquiline-containing or injectable-containing rifampicin-resistant tuberculosis treatment regimens in South Africa: a retrospective cohort study. Lancet Infect Dis. 2022; 22: 1042-1051 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 3 WHOGlobal tuberculosis report 2022. World Health Organization, Geneva2022 Google Scholar Although COVID-19 has undermined global progress, many African countries have sustained declines in tuberculosis mortality rates. With excellent short-course preventive regimens and several late-stage vaccine candidates, tuberculosis prevention is also on the cusp of a revolution. Still, much more can be done to fully implement the Commission's recommendations (panel 1) and realise the ambitious targets set out at the UN High-Level Meeting (HLM) on tuberculosis in 2018. In the 5 years since the HLM, more than 7 million people have died of tuberculosis; their deaths are a profound tragedy and a reminder of the urgency of accelerating momentum. Panel 1Commission recommendationsIn a restatement of recommendations made in the original Commission report, 1 Reid MJA Arinaminpathy N Bloom A et al. Building a tuberculosis-free world: The Lancet Commission on tuberculosis. Lancet. 2019; 393: 1331-1384 Summary Full Text Full Text PDF PubMed Scopus (204) Google Scholar we call for all countries to invest in tuberculosis not only as a moral imperative, but as an effective fortification against other pandemics and a central component of universal health coverage. Optimise access to comprehensive clinical care for all individuals wherever they seek evaluation and care for tuberculosis •Commit to expanding universal access to molecular assays as the standard of care for diagnosing tuberculosis everywhere •Commit to ensuring universal access to shorter, less toxic, oral regimens for both drug-sensitive and drug-resistant tuberculosis •Commit to implementing the social protection strategies necessary to ensure all people seeking or receiving tuberculosis care can access diagnostic and treatment services without risk of catastrophic cost, including in the private health sector Reach people and populations at higher risk •Begin outreach with the most easily identified people, such as household members and other close contacts of people with tuberculosis and people with HIV, and support them during care and treatment •Address stigma and gender and human rights barriers to equitable, quality care, and increase commitment to achieving universal health coverage •Commit to ensuring every eligible person at risk for tuberculosis, including people living with HIV and all household contacts regardless of their age, is screened and treated if positive for tuberculosis, and offered short, 1-month or once weekly treatment regimens for tuberculosis prevention if negative Increase development assistance for tuberculosis •Commit to expanding donor assistance, particularly in low-income countries, including increasing Global Fund allocations for tuberculosis from 18% to 33% of all Global Fund resources •Donor financing for tuberculosis in middle-income countries should be contingent on countries mobilising additional domestic resources •Align new pandemic funding priorities with tuberculosis funding priorities; donor assistance for tuberculosis is likely to deliver far-reaching global health benefits and strengthen global pandemic preparedness, especially in low-income and middle-income countries with the highest burdens Increase investment to accelerate tuberculosis research and development •Commit to increased, sustained funding for tuberculosis research and development for new and better diagnostics, therapeutics, and vaccines, as these are crucial to ending tuberculosis both among people with low income in middle-income countries and globally •Prioritise inclusive clinical research as key groups of people affected by tuberculosis, such as children and pregnant people, cannot yet benefit from scientific advances that have enabled treatment to be shortened •Prioritise research on the implementation of outreach programmes to groups of people at high risk for tuberculosis •Ensure that new tuberculosis technologies (especially those funded through public investments) are available as public goods; high-burden countries should use legal and other tools to accelerate equitable access to tuberculosis innovation. Hold countries and key stakeholders accountable •Empower tuberculosis survivors and other people affected by tuberculosis to serve as leaders in defining and leading the global tuberculosis agenda •Commit to aligning progress towards tuberculosis targets with strategies for advancing pandemic preparedness and response initiatives at global and national levels, including incorporating tuberculosis within frameworks for pandemic preparedness and response funding and governance •Continue to hold governments in high-burden countries accountable to ensure they commit financial resources and political action to driving change In a restatement of recommendations made in the original Commission report, 1 Reid MJA Arinaminpathy N Bloom A et al. Building a tuberculosis-free world: The Lancet Commission on tuberculosis. Lancet. 2019; 393: 1331-1384 Summary Full Text Full Text PDF PubMed Scopus (204) Google Scholar we call for all countries to invest in tuberculosis not only as a moral imperative, but as an effective fortification against other pandemics and a central component of universal health coverage. Optimise access to comprehensive clinical care for all individuals wherever they seek evaluation and care for tuberculosis •Commit to expanding universal access to molecular assays as the standard of care for diagnosing tuberculosis everywhere •Commit to ensuring universal access to shorter, less toxic, oral regimens for both drug-sensitive and drug-resistant tuberculosis •Commit to implementing the social protection strategies necessary to ensure all people seeking or receiving tuberculosis care can access diagnostic and treatment services without risk of catastrophic cost, including in the private health sector Reach people and populations at higher risk •Begin outreach with the most easily identified people, such as household members and other close contacts of people with tuberculosis and people with HIV, and support them during care and treatment •Address stigma and gender and human rights barriers to equitable, quality care, and increase commitment to achieving universal health coverage •Commit to ensuring every eligible person at risk for tuberculosis, including people living with HIV and all household contacts regardless of their age, is screened and treated if positive for tuberculosis, and offered short, 1-month or once weekly treatment regimens for tuberculosis prevention if negative Increase development assistance for tuberculosis •Commit to expanding donor assistance, particularly in low-income countries, including increasing Global Fund allocations for tuberculosis from 18% to 33% of all Global Fund resources •Donor financing for tuberculosis in middle-income countries should be contingent on countries mobilising additional domestic resources •Align new pandemic funding priorities with tuberculosis funding priorities; donor assistance for tuberculosis is likely to deliver far-reaching global health benefits and strengthen global pandemic preparedness, especially in low-income and middle-income countries with the highest burdens Increase investment to accelerate tuberculosis research and development •Commit to increased, sustained funding for tuberculosis research and development for new and better diagnostics, therapeutics, and vaccines, as these are crucial to ending tuberculosis both among people with low income in middle-income countries and globally •Prioritise inclusive clinical research as key groups of people affected by tuberculosis, such as children and pregnant people, cannot yet benefit from scientific advances that have enabled treatment to be shortened •Prioritise research on the implementation of outreach programmes to groups of people at high risk for tuberculosis •Ensure that new tuberculosis technologies (especially those funded through public investments) are available as public goods; high-burden countries should use legal and other tools to accelerate equitable access to tuberculosis innovation. Hold countries and key stakeholders accountable •Empower tuberculosis survivors and other people affected by tuberculosis to serve as leaders in defining and leading the global tuberculosis agenda •Commit to aligning progress towards tuberculosis targets with strategies for advancing pandemic preparedness and response initiatives at global and national levels, including incorporating tuberculosis within frameworks for pandemic preparedness and response funding and governance •Continue to hold governments in high-burden countries accountable to ensure they commit financial resources and political action to driving change Beyond individual inclusion, investment in affected communities is needed to end tuberculosisIn a seminal 1983 advocacy piece, HIV activist Larry Kramer wrote, "I am angry and frustrated almost beyond the bound my skin and bones and body and brain can encompass. My sleep is tormented by nightmares and visions of lost friends, and my days are flooded by the tears of funerals and memorial services and seeing my sick friends. How many of us must die before all of us living fight back?"1 Full-Text PDF