The WHO European Region has made remarkable strides in the battle against tuberculosis (TB) over the past 2 decades, with a staggering 52% cumulative decrease in TB incidence since 2012, far surpassing the global average of 1.9%. However, this success story is overshadowed by looming challenges that threaten to undo any gains made.
WHO/Europe experts are now warning of unmet needs, treatment gaps and vulnerable supply security, particularly concerning access to TB medicines in countries with low prevalence. In addition, legal, financial and regulatory barriers are obstructing access to alternative global supplies, demanding immediate cooperation and a renewed vision for TB elimination in the Region.
“Our Region stands at a crossroads, with the opportunity to lead the world in demonstrating the feasibility of TB elimination, but only if it addresses the critical issues plaguing TB medicine supply,” said Dr Natasha Azzopardi-Muscat, Director of Country Health Policies and Systems at WHO/Europe, and one of the co-authors in the study.
Here is a closer look at the key findings and proposed solutions.
TB control in Europe – successes and challenges
The Region’s battle against TB has yielded remarkable results, with a 52% decrease in TB incidence since 2012, driven by an average annual decline of 7.7%. This significantly outpaces the global average, raising hopes of eventual TB elimination in the Region.
Despite this encouraging progress, the Region faces considerable challenges in TB control, with WHO joining other partners – the European Union (EU), as well as regional networks of physicians and patient organizations – in raising concerns about the current state of control. The European Centre for Disease Prevention and Control (ECDC) recently issued a warning that EU countries are falling short of their 2030 goal to end the TB epidemic. The decline in TB cases, particularly in low-incidence countries, poses a growing threat to the commercial incentives for supplying TB treatments.
The Global Drug Facility (GDF), a donor-supported global health initiative, has successfully negotiated price reductions and introduced new TB products. However, these usually target low- and middle-income countries, leaving high-income countries, including those in the EU, with limited access to GDF products. This inequality raises concerns about the sustainability of TB control across the Region.
This then translates into concrete challenges for patients crossing borders, especially during emergencies. For example, when Ukrainian TB patients sought refuge from the war in EU countries, they were often unable to maintain their treatment continuity. This can have serious implications.
The lack of interoperability between multilateral and country regulatory systems hinders the flow of TB medicines, leading to legal, financial and regulatory complications. Experts argue that seamless global access to all existing TB medicines and infectious disease products is essential, benefiting both high-income countries and global health initiatives.
Treatment gaps and deteriorating outcomes
There are concerning treatment gaps and unmet needs in high-income countries, with children with TB, those with latent TB, and multidrug-resistant TB (MDR-TB) patients being particularly affected. High prices, product gaps and supply vulnerabilities pose significant challenges. Smaller countries in the Region and those transitioning away from donor support face the most significant struggles.
WHO/Europe’s warning comes against the backdrop of a high-level meeting on TB taking place at the United Nations General Assembly in New York. The meeting – “Advancing science, finance and innovation, and their benefits, to urgently end the global tuberculosis epidemic, in particular, by ensuring equitable access to prevention, testing, treatment and care” – aims to review progress to date in terms of achieving the objectives set out in the Sustainable Development Goals.
Speaking from the United Nations General Assembly, Dr Nino Berdzuli, WHO Representative in Poland and Special Envoy for Ukraine Emergency Response in Refugee Hosting Countries, said: “Europe is celebrating significant strides in TB control but there are pressing challenges nonetheless and WHO/Europe is urging immediate action. Collaboration at both national and international levels is essential to ensure sustained progress in TB control and to reduce the burden of this preventable and curable disease across the continent. Europe has the opportunity to set an example for the world in its fight against TB, but only if it takes bold and decisive steps to overcome these obstacles.”