The World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) have an important message: efforts to reach 2030 goals to end tuberculosis (TB) in Europe are currently insufficient.

Europe has made important gains over the past few years. However, WHO and ECDC report that one of the fastest declines in TB incidence and mortality in the world has been slowed by COVID-19 pandemic-related interruptions to diagnosis and care, coupled with the increasing burden of drug resistance and below-target treatment success.

According to the latest ECDC/WHO report on TB Surveillance and Monitoring, there were 164,187 new and relapsed TB diagnoses in 2020. This is an improvement over 2019 numbers (216,368 new/relapsed cases). But in 2021, more than 166,000 new/relapsed cases were reported.

Drug resistance is partially to blame. One in three pulmonary TB cases in the European Region are resistant to rifampicin, and roughly a third of rifampicin-resistant (RR) patients are considered multidrug-resistant (MDR) as they are also resistant to fluoroquinolones. In 2021, 3.8% of cases involved MDR-TB.

TB-HIV coinfections have likewise interrupted progress. Between 2007 and 2016, coinfected cases increased by 8% (from 4% to 12%). In 2021, HIV prevalence in TB cases was an estimated 13%.

Still, according to the report, treatment outcomes for drug-resistant and HIV-positive TB cases are positive overall. More than half (51.7%) of the 781 RR/MDR-TB cases reported in 2019 with known treatment outcomes in 2021 were treated successfully. Six countries—Austria, Belgium, Estonia, the Netherlands, Slovakia, and Sweden—had treatment success above the target of 75%. At 36 months, treatment success for extremely drug-resistant TB was 66.7%.

Of the 426 TB-HIV coinfections with notifiable treatment outcomes in 2020, 53.5% were treated successfully. According to ECDC/WHO, greater reporting and surveillance efforts are needed in the prison population, who carry a relative risk for new and relapsed TB cases of 8.9 compared with the general population in the same countries.

The Tuberculosis Action Plan for the WHO European Region 2023-2030 underscores the need for a harmonised approach to monitoring progress toward reducing TB incidence by 80% and deaths by 90% at the national and regional levels. But monitoring alone cannot address the burden of TB in the European Region. Ongoing evaluation of the impact of strategic interventions is needed to provide a foundation for advocacy and policy development.

Europe needs to regain lost ground in fight against TB

November Challenge

Topic Challenges