End TB Strategy
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| End TB Strategy | |
|---|---|
| Name | End TB Strategy |
| Launched | 2014 |
| Agency | World Health Organization |
| Area | Global |
| Focus | Tuberculosis control and elimination |
End TB Strategy
The End TB Strategy is a global policy framework adopted by the World Health Assembly under the World Health Organization to accelerate reduction of tuberculosis burden and move toward elimination. It builds on previous initiatives such as the DOTS expansion and aligns with the Sustainable Development Goals and the Global Fund to Fight AIDS, Tuberculosis and Malaria investments. The strategy sets time-bound targets, describes core pillars of action, and defines monitoring and financing priorities to reshape international responses to Mycobacterium tuberculosis.
Background and Rationale
The strategy was developed in the context of the persistent global burden documented by the Global Burden of Disease Study, the Stop TB Partnership advocacy campaigns, and recurring high-burden reports from the World Health Organization. It responded to gaps highlighted during reviews of the Directly Observed Treatment, Short-course era, evaluations by the Joint United Nations Programme on HIV/AIDS, and lessons from national programs in India, South Africa, Brazil, Russia, and China. Scientific advances in diagnostics such as Xpert MTB/RIF, therapeutics including new regimens evaluated in trials like those reported by the New England Journal of Medicine, and health-systems insights from Primary health care reforms informed the rationale. The strategy frames tuberculosis as intersecting with HIV/AIDS, diabetes mellitus comorbidity, and social determinants documented by World Bank analyses.
Targets and Milestones
The framework sets progressive global milestones for 2020, 2025, 2030, and 2035, reflecting commitments made at forums including the UN General Assembly high-level meeting on TB. Milestones quantify reductions in TB incidence, TB mortality, and catastrophic costs to households; these echo targets embedded in the 2030 Agenda for Sustainable Development and the disease-specific goals of the Stop TB Partnership. The numeric goals aim for major declines consistent with modeling studies published in journals such as Lancet Global Health and syntheses by the Institute for Health Metrics and Evaluation. National adaptations translate these global milestones into national strategic plans submitted to financing mechanisms like the Global Fund and technical reviews by the WHO Global TB Programme.
Strategic Pillars and Interventions
The strategy defines three interconnected pillars: integrated, patient-centered care and prevention; bold policies and supportive systems; and intensified research and innovation. Pillar 1 emphasizes active case-finding, rapid bacteriological and molecular diagnostics exemplified by GeneXpert deployment, standardized shorter regimens tested in randomized trials, and linkage to antiretroviral therapy for People Living with HIV/AIDS. Pillar 2 includes health financing models evaluated by the World Bank, legal frameworks reviewed in WHO policy briefs, human resources shaped by lessons from Brazilian Unified Health System reforms, and social protection measures aligned with Universal Health Coverage initiatives advanced by the United Nations. Pillar 3 prioritizes new drugs like bedaquiline and delamanid evaluated in multicenter trials coordinated with agencies such as the European Medicines Agency and the US Food and Drug Administration, vaccine candidates advanced through platforms in Gates Foundation–funded consortia, and operational research networks including the TB Alliance.
Implementation and Global Coordination
Countries adapt the strategy into national strategic plans submitted to partners including the Global Fund, bilateral donors such as United States President's Emergency Plan for AIDS Relief, and technical agencies like the Stop TB Partnership and WHO Regional Office for Africa. Implementation relies on coordination with Ministry of Health-level programs (illustrated by national TB programmes in Indonesia and Philippines), integration with HIV services, collaboration with civil society groups such as Treatment Action Group and patient networks, and procurement mechanisms used by UNICEF and the Global Drug Facility. Multilateral governance has been reinforced through high-level pledges at UN General Assembly meetings and interagency mechanisms convened by WHO and the World Health Assembly.
Monitoring, Evaluation, and Impact
Monitoring uses standardized indicators collected through national surveillance systems, periodic prevalence surveys coordinated with institutions like the Centers for Disease Control and Prevention and analytic models from the Institute for Health Metrics and Evaluation. WHO annual global TB reports synthesize case notifications, drug-resistance surveillance tied to WHO Supranational Reference Laboratory Network, and patient cost surveys undertaken with World Bank methodologies. Impact assessment draws on population-level studies, cohort analyses reported in The Lancet and operational research led by the European Centre for Disease Prevention and Control. Financing tracking aligns with estimates from the Global Fund replenishments and UN financing platforms to assess resource gaps and domestic financing commitments.
Challenges and Criticisms
Critics point to implementation gaps in high-burden settings such as South Africa, India, and Nigeria where health-system constraints, diagnostic access inequities, and drug-resistance trends complicate target achievement; these issues have been debated in fora including the World Health Assembly and publications in BMJ and The Lancet. Concerns involve insufficient domestic financing highlighted by World Bank analyses, slow scale-up of new diagnostics despite approvals by the US Food and Drug Administration, and ethical debates about trial designs raised by global research networks. Operational challenges include integrating TB care with HIV/AIDS and noncommunicable disease programs, maintaining supply chains like those coordinated through the Global Drug Facility, and generating transformative vaccines—areas prioritized by the Coalition for Epidemic Preparedness Innovations and the TB Alliance. The strategy's reliance on multisectoral action has provoked scrutiny over accountability mechanisms at regional forums such as the African Union and the European Commission.