In combatting COVID-19, many countries around the world are currently facing “house on fire moments,” as described by Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. However, the syndemic of COVID-19 and TB poses an even more deadly threat. 

TB and COVID-19 respiratory diseases affect mostly the same vulnerable populations. Disproportionately, marginalized communities, those living in poverty, those with underlying conditions, those who don’t have access to clean drinking water or sanitation, and those who can’t afford masks or are unable to socially distance have been hit hardest medically and socioeconomically by both COVID-19 and TB. 

According to Madhukar Pai, associate director of the McGill International TB Center, 25 years of progress in malaria, TB, HIV detection and treatment, as well as widespread vaccinations of vaccine preventable diseases and care for non-communicable diseases, has been rolled back in 25 weeks. He and Osterholm were both speaking at a session at the 51st Union World Conference on Lung Health on Thursday. 

COVID-19 has severely disrupted health systems and services globally. 1.4 million people died from TB-related illnesses in 2019. With a 25 percent disruption in TB detention and treatment, 13 percent more TB deaths could potentially occur this year, found the recent WHO Global Tuberculosis Report. In addition, a decade’s worth of progress in reducing deaths from TB, the world’s oldest known and still the most deadly infectious disease, has been pushed back over the 10 months of the pandemic. 

The infrastructure laid down by TB systems and programmes was in fact essential to mounting the early response to COVID-19, particularly in low- and middle-income countries. 

“When this virus hit us, many countries were able to leverage existing capacities, be it the influenza surveillance systems or the molecular diagnostic testing capacities of TB programs, to respond more effectively to COVID-19,” said Maria Van Kerkhove, WHO COVID-19 Technical Lead. 

In order to rebuild the disrupted health systems, Pai called for the leveraging and repurposing of innovative COVID-19 systems and technologies to fight TB. 

“The amount of investments that have gone into COVID-19 vaccines in six to eight months exceeds all the investments ever made on TB vaccines in the history of humanity. How is this acceptable, given the death toll that TB has cost in the last several years. We must ensure that these R&D investments are not wasted,” said Pai. 

The same infrastructures that have been created to respond to and manage the COVID-19 pandemic could revolutionize TB detection, treatment, and care, if they were applied to the latter. These include: 

• Mobile apps designed for COVID-19 self-assessment, public education, screening, and contact tracing, all of which are necessary for TB. 
• Innovative diagnostics, such as digital chest x-rays using artificial intelligence based software, could be used to screen for both COVID-19 and TB. 
• Decentralized, community based testing could be scaled up for TB.
• Remote service provision systems and technologies, including tele-health and at-home delivery of medicines, could be repurposed for both COVID-19 and TB. 
• Behavioral changes in healthcare facilities, with wearing PPE, and among the public, with distancing and wearing face masks, can interrupt transmission for TB and COVID-19. 
• Global partnerships, such as COVAX – a multilateral collaboration of over 171 countries, established to pool funding for COVID-19 vaccine development and distribution – are critical to increase access to research, technology, and treatment for TB. 

“If we don’t use this crisis and invest in universal health coverage [UHC] as a long standing solution for better pandemic preparedness…then TB will suffer because TB desperately needs the protection of UHC,” said Pai. “And therefore my biggest dream would be for UHC to get front and center on the political agenda and for our countries’ leaders to have learned this hard lesson that health is wealth and wealth is health.”

Image Credits: Flickr – World Bank, International Union Against Tuberculosis and Lung Disease.