The World Health Organization reports the death rate from tuberculosis has been cut nearly in half compared with what it was in 1990, but the disease still ranks as a leading worldwide killer.
WHO's Global Tuberculosis Report 2015 shows that 1.5 million people died from TB in 2014, 300,000 more than the number killed by HIV/AIDS.
Dr. Mario Raviglione, director of WHO's Global TB Program, said most deaths from TB could be prevented.
"Despite the gains, the progress made against TB is far from sufficient," he said. "We are still facing a burden of 4,400 people dying every day, which is unacceptable in an era when you can diagnose and cure nearly every person with TB."
What's more, close to half of the deaths from tuberculosis occurred in five countries — China and India, the world's two most populous countries, along with Indonesia, Nigeria and Pakistan.
TB, HIV and poverty
Dr. Eric Goosby, the U.N. special envoy on tuberculosis, said the 47 percent drop in the number of TB cases over the past 35 years was partly due to the world's response to HIV. TB and HIV are often co-occurring infections, because once a person's immune system stops working properly, he becomes more susceptible to catching other infectious diseases. Four hundred thousand people who died in 2014 were infected with both TB and HIV. While it's still high, the number of people dying from HIV has declined over the years.
"The big drops we’ve seen in the HIV/TB [death rates] is because of people going on antiretroviral treatment for HIV," Goosby said.
Another underlying reason why people get TB is poverty, he said.
“They come into care late. They get diagnosed later and have more difficult disease to treat as a result, and their outcomes are poorer because of it," Goosby said. Poverty, he said, makes people vulnerable to getting TB because they are likely to suffer from malnutrition, have poor health care and have less resistance when they come in contact with infectious diseases.
Stigma of disease
There's also the stigma associated with deadly infectious diseases like TB. People in some countries are concerned about even being seen going into a clinic to be treated for TB.
Goosby has extensive experience with tuberculosis and HIV/AIDS as both a clinician and as a developer of policies to control these diseases, and "what I've seen in HIV is that we didn't really significantly drop stigma until we put treatment out there and [made] it available to enough people in the community that individuals, people in the community, did not equate HIV with death."
Goosby said TB has a similar challenge. "People equate TB with being poor, with being dirty, physically dirty, and the shame that that creates will stop somebody from coming to a medical delivery system with clear, frank symptoms indicative of active tuberculosis," he said. "We've got to get over that."
Detection, treatment gaps
The WHO's Global Tuberculosis Report 2015 compiled data on TB from 209 countries and territories. While the report found a 47 percent decline of TB cases in the past 35 years, it also found significant gaps in detecting and treating TB.
Dr. Margaret Chan, WHO director-general, said in a news release, "If the world is to end this epidemic, it needs to scale up services and, critically, invest in research."
Raviglione estimated that close to $3 billion is needed to improve detection; to support research for new drugs to treat the disease; to deliver improved, faster-acting and affordable TB treatments; and to develop a vaccine.
Cost of treatment
Treating TB is expensive, which adds to the reasons some countries don't — or can't — aggressively try to control the disease. An infected person has to go on a daily drug regimen for at least six months, and in the case of multidrug-resistant TB, more than one drug is needed and the treatment lasts longer. The death rate for multidrug-resistant tuberculosis, or MDR-TB, is also high. The WHO report shows the average survival rate is only 50 percent. Plus, MDR-TB is more likely to be underreported. The countries with the greatest number of these cases are China, India and Russia.
Strategy against TB
Because TB is airborne, because it kills so many people and because MDR-TB is spreading, WHO considers it a global epidemic and has a strategy to end it. The goal, starting in 2016, is to reduce the number of new cases by 80 percent and to reduce the number of TB deaths by 90 percent by 2030.
To do this, Goosby said, health care has to be made more available to the poor, and tuberculosis needs to be recognized as the global threat that it is. Goosby sees progress in this development.
"Increasingly, the world is beginning to understand the severity of the TB threat," he said. And as it does, he said, individuals with tuberculosis will be seen as people with a diagnosable, treatable disease and not as lepers.