Aggressive TB control can yield big economic gains

A new World Bank research report finds that 22 countries with the world's highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto a global plan to sharply reduce the numbers of TB-related deaths.

Highly affected African countries could gain up to nine times their investments in TB control. The study also warns about the need to step up TB control worldwide with the growing emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) in southern Africa, eastern Europe and Central Asia.

The report says that despite recent gains in fighting TB, there were still 8.8 million new cases and 1.6 million deaths from the disease in 2005. Without treatment, two thirds of smear-positive cases die within five to eight years, with most dying within 18 months of being infected.

According to the study — "The economic benefit of global investments in tuberculosis control" — the economic impact of TB deaths and the benefits of TB control among the 22 high-burden countries are greatest in China and India, where the combination of growing incomes and a relatively high number of TB deaths translates into a significant economic effect.

The study, which was commissioned by the World Bank on behalf of the Stop TB Partnership and funded by the Bill and Melinda Gates Foundation, has attracted considerable interest from international health and development agencies, along with research and civil society groups, which want more aggressive TB control worldwide. The disease is the leading infectious killer of adults after HIV/AIDS.

“This report set out to test whether the economic benefits of TB control are greater than the costs. It turns out that likely benefits are of impressive magnitude,” said Dr Jorge Sampaio, the UN Secretary-General's Special Envoy to Stop TB, and former President of Portugal.

What the study means for Africa

The study says that the economic cost of TB-related deaths (including HIV co-infection) in Sub-Saharan Africa from 2006 to 2015 is US$ 519 billion when there is no effective TB treatment as prescribed by WHO's Stop TB Strategy. However, if these same countries in Sub-Saharan Africa were to offer such treatment to TB patients, in keeping with a global plan to halve the prevalence and death rates by 2015 relative to 1990 figures, countries could see their economic benefits exceed their costs by about nine times over. The Global Plan to Stop TB, devised by the Stop TB Partnership, would cost US$ 2 billion a year for TB diagnosis and treatment until 2015 in Africa, and US$ 5-6 billion worldwide.

“There were already compelling reasons to fight TB, which causes massive human suffering. Now, as a further incentive, there are strong indications that investment in meeting the Millennium Development Goal related to TB carries important economic benefits,” said Dr Margaret Chan, Director-General of WHO.

Stepping up TB treatment also makes economic sense outside Africa. The study finds that the economic return would be even higher in countries such as China and India, where income growth projections over the next 10 years are higher and the burden of HIV co-infection lower.

TB worsens poverty

The new study says that by sickening or killing working-age adults, TB imposes a heavy cost on people's incomes as well as national economies. For example, in Zambia, adult deaths among small maize and cotton farmers caused crop yields to fall by roughly 15%. Children are vulnerable to TB as well, and the disease may force them out of school, limiting their future job prospects.

“This important new study shows us why TB control is a smart investment in lasting development for low- and middle-income countries,” said Joy Phumaphi, World Bank Vice-President for Human Development, a former WHO Assistant Director General and former Health Minister in Botswana. “This economic justification for TB control strengthens the case for governments and donors to sharply reduce TB prevalence and deaths in the name of better health and higher incomes for people living at grave risk of TB illness and death.”

Phumaphi says the World Bank will intensify its support for TB control, while continuing to work with countries in eastern Europe, Central Asia and South Asia. In Africa, she says the Bank will take a more proactive approach to financing country-led efforts, using existing channels, sector-wide programmes, combined HIV and TB control programmes, and multi-sectoral operations.

Looking ahead

The study calls for urgently accelerated global TB control because of multiple factors: the extraordinary burden of TB on those afflicted by the disease, their families, and on government budgets; the dramatic growth of TB cases over more than a decade in eastern Europe and Central Asia; and the emergence of MDR-TB and XDR-TB. TB patients in eastern Europe and Central Asia are 10 times more likely to have MDR-TB than in other regions of the world, and up to 15% of new cases are multi-drug resistant. The report says the threat of MDR-TB underscores the urgency for all TB-affected countries and health and development agencies to push for the fullest possible adoption of the Global Plan to Stop TB; the plan calls for a shared investment by countries heavily affected by TB and donors.

"This report should wake up countries to the urgent need for a stronger financial commitment to TB control," said Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "Effective TB control has a positive impact on the lives of the millions of people infected with TB, on whole communities and it reduces the burden of disease on national economies."

The 22 countries with a high burden of TB are: Afghanistan, Bangladesh, Brazil, Cambodia, China, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, South Africa, Thailand, Uganda, United Republic of Tanzania, Viet Nam and Zimbabwe.

The Global Plan to Stop TB, launched by the Stop TB Partnership in January 2006, sets forth a roadmap for treating 50 million people for TB and enrolling 3 million patients who have both TB and human immunodeficiency infection on antiretroviral therapy over the next 10 years, saving about 14 million lives. It aims to halve TB prevalence and deaths compared with 1990 levels by 2015.

The Stop TB Partnership, which is hosted by WHO in Geneva, Switzerland, is a network of more then 500 international organizations, countries, donors from the public and private sectors, and nongovernmental and governmental organizations that are working together to eliminate TB.

The Stop TB Strategy, launched by WHO in 2006, includes the following priorities:

• pursue high-quality DOTS expansions and enhancement (the DOTS approach to TB control emphasizes bacteriologically-based case detection and standardized treatment with patient support, effective drug supply and monitoring and evaluation);
• address TB/HIV, MDR-TB and other challenges;
• contribute to health system strengthening;
• engage all care providers;
• empower people with TB and communities; and
• enable and promote research.

http://www.who.int/