Every hour, 49 people are diagnosed with and 7 die from tuberculosis. Are health systems failing to save them?

Copenhagen, 17 March 2008

Every hour, 49 people are diagnosed with and 7 die from tuberculosis.

Health systems in many countries in the WHO European Region struggle to meet the needs of tuberculosis (TB) patients, and are too short of funds and staff to ensure good surveillance and control of multidrug-resistant and extensively drug-resistant TB (MDR- and XDR-TB).

According to the most recent global WHO TB report, although most of the countries in the Region have managed to reduce TB incidence, MDR-TB and XDR-TB rates have soared over the past decade. This has created greater demands on health services, but resources have not climbed in response.

On the eve of the World TB Day, celebrated worldwide on 24 March, the WHO Regional Director for Europe, Dr Marc Danzon says: “During the last decades we have concentrated a great deal on TB. At the same time we have collectively failed to reduce the number of relapses of the disease and to make sure health systems can ensure that the right doses and duration of treatment are chosen and applied. We often fail to focus on how the health system can tackle the drug-resistance issue. It is time for decisive action now!”

In 2006, there were about 9.2 million new cases and 1.7 million deaths from TB worldwide. These figures include 433 261 new cases and 62 197 deaths in the WHO European Region: 49 new cases and 7 deaths every hour.

Based on recently published data, WHO estimates that 490 000 cases of MDR-TB and 40 000 cases of XDR-TB occur every year worldwide.1 Of the 14 areas worldwide most affected by MDR-TB, 12 are in the eastern part of WHO European Region. The proportion of XDR-TB, which is even more difficult, time-consuming and expensive to treat, ranges from 4% of all newly diagnosed MDR-TB cases in Armenia to almost 24% in Estonia. High percentages are also found in areas of Azerbaijan, Moldova and Ukraine (22.3%, 19.4% and 16%, respectively).

Health systems throughout the Region face challenges in tackling drug-resistant TB. The problem must be addressed seriously everywhere, since cases of MDR- and XDR-TB have also been reported in western European countries. Almost all countries in the Region are reforming their health systems, to strengthen their capacity to respond to the resurgence of diseases such as TB.

“Strong health systems, with improved laboratory networks, drug distribution systems and human resource capacity, and quality specialized TB services integrated into primary health care are better fitted to carry out well-designed TB control strategies and achieve results,” says Dr Nata Menabde, Deputy Regional Director, WHO Regional Office for Europe.

In western Europe, health systems need to address TB in marginalized and socially disadvantaged groups living in pockets of deprivation in many major cities, as well as among asylum seekers and migrant workers. Eastern countries share this problem; in addition, insufficient collaboration between partners (such as primary health care services and specialized services, including those for HIV/AIDS and prison health) hampers work to control TB.

Putting health systems high on the political agenda and addressing their contribution to health, the economy and ultimately social well-being are key objectives of the WHO European Ministerial Conference on Health Systems: “Health Systems, Health and Wealth”, which will take place in Tallinn, Estonia, on 25–27 June 2008. These objectives are strongly linked with European societies’ ability to address such problems as drug-resistant TB.

WHO European plan to stop TB

Last year, the WHO Regional Office for Europe launched the Plan to Stop TB in 18 High-priority Countries in the WHO European Region, 2007–2015. It focuses on: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. The total cost of implementing the Plan is US$ 14.8 billion, with a funding gap estimated at US$ 8 billion.

More on TB

  • TB is contagious and spreads through the air; if not treated, each person with active TB infects, on average, 10–15 others every year.
  • One in ten people infected with TB bacilli will become sick with active TB in his or her lifetime. People with HIV are at much greater risk.
  • TB is a disease of poverty, mostly affecting young adults in their most productive years.
  • When TB is not treated properly, MDR- and XDR-TB can develop. This can happen, for instance, when the necessary combination of drugs, their doses and the duration of treatment are not adequately chosen and applied.
  • Treating MDR- and XDR-TB can be up to 100 times more expensive than regular treatment. It requires more expensive drugs, can take up to two years and carries the risk of more side-effects; in addition, the strains of TB bacteria that have grown resistant to the more cost-effective drugs can be extremely difficult to treat.

TB targets

The World Health Assembly target for 2005 was for countries to detect at least 70% of sputum-smear-positive (infectious) TB cases and successfully treat 85% of detected cases. Globally, 26 countries achieved the target; the remainder will continue to pursue it.

For 2015, the Millennium Development Goals call for halting and beginning to reverse incidence. The associated Stop TB Partnership target is to halve prevalence and deaths in comparison with 1990.

The Stop TB Partnership calls for the elimination of TB as a public health problem by 2050.

For further information contact:


Dr Risards Zaleskis
Regional Adviser, Communicable Diseases
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel.: +45 39 17 13 35. Fax: +45 39 17 18 51.
E-mail: rza@euro.who.int


Ms Liuba Negru
Press and Media Relations Officer
WHO Regional Office for Europe
Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark
Tel.: +45 39 17 13 44. Fax: +45 39 17 18 80
E-mail: LNE@euro.who.int