COVID-19 Eliminates Twelve Years of Progress Against Tuberculosis, Global Investment Needed
In just one year COVID-19 has undone 12 years or progess in the fight against tuberculosis.

In just one year, COVID-19 has undone more than a decade’s progress in the fight against tuberculosis (TB), health experts said on Thursday.

While COVID-19 fatality numbers are decreasing worldwide, TB-related deaths remain steady at 4000 cases a day – an occurrence experts partly attribute to limited access to TB treatment services during COVID lockdown periods and TB funds being diverted to fight the virus.

“Twelve years of impressive gains in the fight against TB, including in reducing the number of people who were missing from TB care, have been tragically reversed by another virulent respiratory infection,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership

The STOP TB Partnership shared new data on Thursday showing that nine of the countries with the most TB cases – representing 60% of the global TB burden – saw a drastic decline in in diagnosis and treatment of TB infections in 2020, ranging from 16 – 41% (with an average of 23%). The drop brought the overall number of people diagnosed and treated for TB in those countries to 2008 levels. 

Annual percentage change in TB diagnosis and enrollment for nine high-TB burden countries

There are many similarities between TB and COVID-19. Both are airborne infections transmitted through breathing, affecting primarily the respiratory tract, and causing similar symptoms such as cough, fever, and breathlessness. 

Responses to COVID-19 and TB are also similar, including testing, tracing, masking, isolation, and airborne infection control in health care and other settings. 

When the COVID-19 pandemic started in high burden countries, TB program expertise and resources were used to respond to virus.But, as a result of lockdowns, TB diagnostic and treatment services became inaccessible, greatly impacting the amount of people reached and treated. 

As the number of people vaccinated against COVID-19 grows, the number of COVID-19 deaths decrease while TB will continue to kill roughly 4000 people every day, the new data shows.

“In the process, we put the lives and livelihoods of millions of people in jeopardy. I hope that in 2021 we buckle up and we smartly address, at the same time, TB and COVID-19 as two airborne diseases with similar symptoms,”  Said Ditiu.

Dr Lucica Ditiu, Executive Director of the Stop TB Partnership
Investment in TB ‘Drastically Different’ From COVID-19 

In addition to the worldwide drop in TB diagnosis and treatment, data emerging from India and South Africa shows that people coinfected with TB and COVID-19 have three times higher mortality than those infected with TB alone. This makes contact tracing, case finding, and bi-direction TB and COVID-19 testing essential.

“Why is it that TB, which was not too long ago, a global pandemic killing people all over the world in very large numbers?” asked Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, during a press briefing.

Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria

COVID-19 claimed 1.8 million lives in 2020 and said Sands pointed out that the numbers of people who died from TB in 2020 may have been around 1.7 million, 90% of the number of COVID deaths.. 

But the investment in TB is not as substantial as the investment in COVID-19 – 2% of what is spent on COVID-19 is the amount invested in TB, which Sands called “drastically different in terms of resource commitment.” 

“Why is it that we have left people behind? We haven’t finished the fight against TB, as an older pandemic. Should we not use the forced rethinking of our approaches to global health that COVID has catalyzed?” 

“Let’s really step up our fight against TB, and get rid of it. If we don’t, we are again creating another future risk for humanity in the form of multidrug resistant (MDR) TB.” 

India’s Integrated TB and COVID-19 Response 
The TB programs of several high TB burden countries have made efforts to recover. Some have been more successful than others, such as India.

India was one one of the first countries with a high TB burden that have made vast efforts to recover, developing a rapid response plan by August 2020, after the national government’s TB notification system, “Nikshay,” reported a 70% drop between the 10th and 15th weeks of 2020.

“TB didn’t go anywhere when the COVID-19 pandemic hit,” said Dr. Harsh Vardhan, Minister of Health and Family Welfare, India. “People just got distracted, health workers were redirected, and health systems became overwhelmed. Recovery efforts succeed with political leadership and substantial resources, along with an insistence that COVID-19 outreach and prevention efforts include TB work, instead of replacing it.”

Honorable Harsh Vardhan, Minister of Science and Technology, Minister of Health and Family Welfare, India

The primary goal of the response plan was to integrate TB into all COVID-19 programming, taking advantage of how both infections attack people’s respiratory systems. 

Boosted by public commitment from India’s Prime Minister, efforts to locate TB and COVID-19 cases in all health care facilities intensified, and rapid molecular testing for TB expanded. 

Bi-direction screening of TB and COVID-19 took place for people displaying influenza-like illnesses and severe acute respiratory infections. Contact tracing systems and testing for TB linked to COVID-19 contact tracing were set up, and private care TB facilities were opened. 

India’s response to the simultaneous burden of both TB and COVID-19 has shown that it is possible to integrate approaches to tackle airborne pandemics. “If a nation like India can dream of this, the rest of the world has to think beyond this. We have to admit that the current pandemic has demonstrated the vulnerability of humankind to exigencies, recognizing that we have to strive to add speed and predictability,” said Vardhan.

Investing in TB Creates a ‘Defense System’ Against Respiratory Diseases 

The shift of TB resources to COVID-19 has disproportionately impacted people in low and middle-income countries, which means that more resources and investment towards TB can greatly reduce the double burden of both diseases. 

“We can rein in COVID, and we can protect against new airborne risks in the TB response service platforms to fight current and future airborne diseases, but to succeed, we will need to put equity and human rights at the center of the approach,” said Dr Joanna Carter, Vice-Chair of the Stop TB Partnership Board and Executive Director, RESULTS.

The theme for World TB Day, observed on 24 March, is ‘The Clock is Ticking’, which conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders.  

The theme for World TB Day 2021 is ‘The Clock is Ticking’

Carter Concluded: “This kind of level of annual investment could have a transformative impact on TB efforts globally, and help build the infrastructure that protectings communities in the world against all kinds of airborne diseases. We can’t force a false choice between fighting COVID or fighting TB. Communities, individuals, and health systems are facing both of these challenges, and they have to have the financial and human resources to respond.” 

“If we act ambitiously now, we can make huge progress against TB and COVID, [creating] a defense system against future infectious respiratory disease threats, [protecting] everyone.” 

Image Credits: STOP TB partnership , STOP TB partnership , WHO.

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