The COVID-19 pandemic has reversed years of global progress in tackling tuberculosis and for the first time in over a decade, TB deaths have increased, according to the World Health Organisation’s 2021 Global TB report. 

In 2020, more people died from TB, with far fewer people being diagnosed and treated or provided with TB preventive treatment compared with 2019, and overall spending on essential TB services falling. 

According to the UN agency, the first challenge is a disruption in access to TB services and a reduction in resources. 

It said that in many countries, human, financial and other resources have been reallocated from tackling TB to the COVID-19 response, limiting the availability of essential services. While the second challenge is that people have struggled to seek care in the context of lockdowns. 

“This report confirms our fears that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis,” said the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus. “This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.”

In a press release made available to PUNCH HealthWise, WHO noted that TB services are among many others disrupted by the COVID-19 pandemic in 2020, but the impact on TB has been particularly severe.

“For example, approximately, 1.5 million people died from TB in 2020 (including 214 000 among HIV positive people). 

“The increase in the number of TB deaths occurred mainly in the 30 countries with the highest burden of TB. 

“WHO modelling projections suggest the number of people developing TB and dying from the disease could be much higher in 2021 and 2022.

“Challenges with providing and accessing essential TB services have meant that many people with TB were not diagnosed in 2020. “The number of people newly diagnosed with TB and those reported to national governments fell from 7.1 million in 2019 to 5.8 million in 2020,” it said.

WHO estimates that some 4.1 million people currently suffer from TB but have not been diagnosed with the disease or have not officially reported to national authorities. This figure is up from 2.9 million in 2019. 

The report shows that the countries that contributed most to the global reduction in TB notifications between 2019 and 2020 were India (41 per cent), Indonesia (14 per cent), the Philippines (12 per cent), and China (eight per cent). These and 12 other countries accounted for 93 per cent of the total global drop in notifications. 

It showed that there was also a reduction in the provision of TB preventive treatment. Some 2.8 million people accessed this in 2020, a 21 per cent reduction since 2019. In addition, the number of people treated for drug-resistant TB fell by 15 per cent, from 177,000 in 2019 to 150,000 in 2020, equivalent to only about one in three of those in need.

Funding in the low- and middle-income countries that account for 98 per cent of reported TB cases remains a challenge. Of the total funding available in 2020, 81 per cent came from domestic sources, with the BRICS countries (Brazil, Russian Federation, India, China and South Africa) accounting for 65 percent of total domestic funding. 

“The largest bilateral donor is the Government of the United States of America. The biggest international donor is the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“The report notes a fall in global spending on TB diagnostic, treatment and prevention services, from US$ 5.8 billion to US$ 5.3 billion, which is less than half of the global target for fully funding the TB response of US$ 13 billion annually by 2022. 

“Meanwhile, although there is progress in the development of new TB diagnostics, drugs and vaccines, this is constrained by the overall level of R&D investment, which at US$ 0.9 billion in 2019 falls far short of the global target of US$ 2 billion per year,” WHO noted.

The organisation said reversals in progress mean that the global TB targets are off track and appear increasingly out of reach, however, there are some successes. Globally, the reduction in the number of TB deaths between 2015 and 2020 was only 9.2 per cent – about one-quarter of the way to the 2020 milestone of 35 per cent.

Globally, the number of people falling ill with TB each year (relative to population) dropped 11 per cent from 2015 to 2020, just over half-way to the 2020 milestone of 20 per cent. 

“We have just one year left to reach the historic 2022 TB targets committed by Heads of State at the first UN High Level Meeting on TB. The report provides important information and a strong reminder to countries to urgently fast-track their TB responses and save lives,” said the Director of WHO’s Global TB Programme, Dr. Tereza Kasaeva. “This will be crucial as preparations begin for the 2nd UN High Level Meeting on TB mandated for 2023.”

The report calls on countries to put in place urgent measures to restore access to essential TB services. It further calls for a doubling of investments in TB research and innovation as well as concerted action across the health sector and others to address the social, environmental and economic determinants of TB and its consequences.

 

PUNCH

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