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Vital Strategies calls on governments to implement strong tobacco control and adopt integrated healthcare strategies to strengthen TB response

(New York, USA) – Governments are missing critical opportunities to reduce tuberculosis (TB) and related morbidity and mortality according to Vital Strategies, a global health organization that works in over 60 countries. TB killed around 1.67 million people in 2016; it is the ninth-leading cause of death and the leading cause of death due to a single infectious agent. Eliminating smoking alone could reduce global TB rates by 20% by 2040, but most countries – including the seven countries that account for 64% of the global TB burden (India, Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa) – have not implemented fully comprehensive laws to reduce tobacco use.

Outcomes would also be improved if governments collected and used more accurate data on TB, strengthened human resources within the public health system, delivered an integrated approach to care (for example, providing smoking cessation services in TB clinics), and optimized supportive care for patients and uninterrupted, affordable access to the necessary medicines. A lack of capacity and political commitment to implement these proven policies, coupled with global funding shortfalls for diagnosis and treatment, research, and drug development, threaten progress to stop TB.

“The first UN General Assembly high-level meeting on TB later this year must galvanize political commitment to defeat this global health emergency,” said José Luis Castro, President and CEO, Vital Strategies. “There has been a worrying lack of progress, increases in anti-microbial resistance and a growing funding gap that is preventing much-needed research into potentially life-saving new tools and treatments. Governments must prioritize investment in their health systems and national programs to reduce TB. Several high-burden countries in particular could afford to contribute more and the U.S. should ensure that health budget cuts do not impact TB.”

WHO estimate that 10.4 million people fell ill with TB in 2016. More than half (56%) lived in five countries – India, Indonesia, China, the Philippines and Pakistan ­– and 65% were male. There are high rates of male tobacco use in each of these countries. According to The Tobacco Atlas, cigarette smoking increases the risk of developing TB, and it makes treatment for TB less effective.

TB rates worldwide could decline as much as 20% by 2040 if we eliminated smoking,” said Dr. Neil Schluger, Vital Strategies Senior Advisor on Science and co-author of The Tobacco Atlas. “Tobacco control is TB control. Governments should raise tobacco taxes and ensure smoke-free public places, along with the other WHO MPOWER policy measures.  Other opportunities include integrating smoking cessation programs into the routine services of TB and HIV clinics, which could significantly improve treatment outcomes, as would increasing access to affordable drug treatments and tools like the GeneXPERT diagnostic test. And in high-burden countries, greater investment in increasing the number of pulmonary specialists who are able to diagnose and treat TB – something we’re trying to achieve through our East Africa Training Initiative – would help to reduce under-diagnosis and treatment – key drivers of the epidemic, especially for multi-drug resistant TB.”

Note to Editor

About Vital Strategies’ work to support progress on TB

Vital Strategies is working across 60 countries to strengthen public health systems in ways that support progress against TB. This includes important work supporting the STREAM Clinical Trial, which seeks to determine whether a nine-month treatment regimen for multi-drug resistant TB (MDR-TB) is as effective as the established longer (20-to-24 months) regimen. Stage 1 of the Trial suggests that the shorter regimen is very close to the effectiveness of the longer regimen, when both are given under trial conditions, reduces costs to both the health system and patients, and reduces the pill burden by approximately two-thirds. Vital Strategies’ work has included assisting the Philippines’ government to roll out the shorter regimen and helping stakeholders in Peru to improve the analysis and presentation of TB-related data to support policy discussions.

In ten of the 30 countries with the highest burden of TB – Brazil, China, India, Indonesia, Myanmar, Papua New Guinea, Philippines, Tanzania, Zambia – Vital Strategies is also working with government to strengthen civil registration and vital statistics systems, enabling better measurement of TB incidence and mortality, alongside other causes of death, to inform health policy. In India, the organization has supported The Ministry of Health and Family Welfare in launching anti-tobacco mass media campaigns like “Cough,” which urges smokers with a persistent cough to get tested for TB. In Ethiopia, the East Africa Training Initiative has increased the number of pulmonologists able to diagnose and treat TB and advise Ethiopia’s government on its TB programs, from one in 2013 to 14 in 2018.

About Vital Strategies

Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. Our team combines evidence-based strategies with innovation to help develop and implement sound public health policies, manage programs efficiently, strengthen data systems, conduct research, and design strategic communication campaigns for policy and behavior change. To find out more, please visit or Twitter @VitalStrat.

For further information or to arrange an interview with a Vital Strategies public health and tobacco control expert, please contact