Hello to everybody,
this is Mario Raviglione speaking.
I am at the University of Milan in Italy where I teach global health.
I'm also honorary professor at
the Queen Mary University of London and I used to be the director of
the Global Tuberculosis Program at the World Health Organization,
between 2003 and the end of 2017.
My speech is going to be divided into two parts.
This is Part 1 and the content of the speech is what you see in
the next slide, which illustrates the five points of the entire speech.
Before I start, therefore, to speak specifically
about the End TB strategy which will be the topic of the second lecture,
I will be doing something to place the strategy in a wider context.
First of all, I will address the burden of
tuberculosis so that you have an understanding in a quick summary.
I will speak about the international targets and progress towards those targets.
I will speak about the challenges we have to face today and a bit on the evolution of
the global TB strategy, from what used to be called the
DOTS Strategy to now the End TB Strategy.
The End TB Strategy, in all details will be presented in the next lecture.
I'm starting with addressing a huge burden of disease.
A huge burden of disease is illustrated quite clearly with this new slide.
The latest estimates were published by WHO at the end of 2020, so they refer to 2019.
But tuberculosis is a disease that has a fairly slow evolution
therefore these numbers are not subject to major changes year after year
(with the exception perhaps now in the case of the COVID pandemic
where we will see some important changes and I will mention that).
In any case there are today
roughly 10 million new cases of tuberculosis every year and you see that they
are distributed as 2/3 in males and 1/3
in females with more than a million children affected every year.
In terms of death the best estimate is in the range of 1.4 million people who
die from tuberculosis every year, including
200,000 and 220,000 to be precise in children.
The second row shows the HIV associated tuberculosis,
let me call it co-epidemic, with about 800,000 cases every year,
so it's eight percent of the total 10 million cases. This is
important to remark because while in Africa the situation is very
serious, it's not exactly the same in other parts of the world and in
a way more than 90 percent of the TB cases have nothing to do with HIV.
Sometimes people believe that tuberculosis is so important because of
HIV, that's not exactly the case, and this is the message I wanted to give you.
Where it is, is in the African continent.
There are more than 200,000 people with HIV that die because of TB every year,
making it probably the number one cause of death in the HIV infected people.
The third row shows
the very alarming situation related to multi-drug resistant tuberculosis, which is
a form of tuberculosis that is resistant to
the most important drugs that we use today; isoniazid and rifampicin.
There are almost 0.5 million new cases
every year with probably more than a couple of 100,000 that die.
Finally, the last row there shows you the latently infected people, people who have been
infected with tuberculosis without knowing it because this
is a disease that is very silent in the face of infection.
Some of those will evolve towards then the disease.
There are, we estimate, now almost two billion people that have, in one way or another,
been in contact with
the tuberculosis bacillus and as a result they have become infected.
However, only a minority of those will evolve towards the active disease.