Gap of Undiagnosed TB Cases Narrows as Global Response Rebounds from COVID   
Lucica Ditiu, Executive Director Stop TB at the World TB Summit in Varanessi, India

After major setbacks during the pandemic, TB diagnosis and treatment appears to have rebounded with the number of undiagnosed TB-infections estimated at less than three million people in 2022- the lowest ever. 

That’s according to preliminary data released by the Stop TB Partnership, on Friday, World TB Day. 

“In 2022 the gap between the estimated number of people with TB and those diagnosed and treated was the lowest ever—with less than 3 million missing people with TB. This gap was 3.2 million in 2019, 4.3 million in 2020, and 4.2 million in 2021,” stated the Partnership in a press release coinciding with the One World TB Summit, in Varanessi India.

At the Summit, the Partnership also announced a new “high-level advocacy platform” to reinvigorate commitments to eliminate TB as a public health threat by 2030, in line with the Sustainable Development Goals.  

“We are making history because we are meeting here in India, which is the highest burden of TB but also the highest ambition to end TB,” declared Lucica Ditiu, executive director of the STOP TB Partnership at a press briefing in Varanessi. 

Along with India’s Minister of Health, Mansukh Mandaviya, the briefing included leading health officials from other countries that have pledged to lead the charge in the campaign, including Indonesia and Brazil as well as South Africa and Nigeria.   

“We are changing the narrative about TB. We are saying “Yes we can end TB!” declared Ditiu, in reference to the Summit’s theme, hearkening back to the “Yes We Can” campaign slogan that helped propel former Barack Obama to the US Presidency in 2008.  

“There are things that are happening in all of these amazing countries and beyond,” she added, citing, for India: “the fact that people receive, every month, direct cash for treatment, that people are paired with friends who support them through the treatment.” 

Working with communities, private sector, care providers to increase testing

We have been working closely with communities, private sector care providers and others to increase awareness about increased testing and reaching all those who are affected by TB,” said Mandaviya, at the press briefing.   

Added Dr Ethel Maciel, Brazil’s deputy minister of health,  “Poverty is very close to TB disease, so we should fight against this. The new government has a special plan to fight against hunger and poverty, as well as increasing social protections and respect for human dignity. We all know that high TB affects the most vulnerable, the most vulnerable get even more vulnerable from this disease. 

“All of the things we learned in the COVID pandemic, we can put towards eliminating TB.  Close collaboration, sharing knowledge. We can do much more when we are united, when we have transparency. Today is a day of hope – that we can end TB. 

Maxi Rein Rodonuwu, director general, disease prevention and control, Ministry of Health, Indonesia

Indonesia, with the world’s fourth largest burden of TB, also made significant progress in 2022. 

Almost three-quarters of the estimated TB caseload was diagnosed and treated, with the overall treatment success rate at 84%—the highest rates recorded for Indonesia. Key to the success of the National TB Program was the deployment of screening campaigns similar to what was used for COVID-19, said Maxi Rein Rondonuwu, Director General of Disease Prevention and Control at the Ministry of Health.

Coalition of leaders set to launch initiative at UN General Assembly 

Speaking at the TB Summit opening, Indian Prime Minister Narendra Modi appealed to the G20 group of industrialized nations to support TB elimination. India holds the presidency of the G-20 this year, with heads of state set to meet in September in New Delhi.  

“The theme of the G20 is a resolution for the shared future of the entire world,” said Modi. “India’s efforts are a new model for the global war on TB. People’s participation in the fight against TB is India’s big contribution. India is now working on the target of ending TB by the year 2025. I would like that more and more countries get the benefit of all campaigns, innovations and modern technology of India,” added the Prime Minister. 

Along with the heads of state of India and Brazil, the coalition set to lead the “Yes We Can” campaign also includes Indonesia, South Africa, and the newly elected President of Nigeria, Bola Tinubu. The ‘Coalition of Leaders’ will be formally launched during the United Nations (UN) General Assembly week in New York City in September 2023.

Rebounding from the pandemic 

About 1.1 million children and young adolescents aged under 15 years are diagnosed with TB every year, and over 225,000 of them lose their lives.

Last year’s rollback in undiagnosed TB cases came as high TB burden countries—including Brazil, Nigeria, India and Indonesia—increased the number of people diagnosed and enrolled on treatment, exceeding the numbers seen before the COVID-19 pandemic. 

Despite this progress, TB was once again the world’s biggest infectious disease killer in 2022 – the delayed effect of setbacks in diagnosis and treatment over three pandemic years. So 2023 remains a critical moment as the international community prepares for the second UN High Level Meeting (UNHLM) on TB, 22 September 2023 (UNHLM), on the margins of the UN General Assembly in New York City. 

“With the world regaining strength as the COVID-19 pandemic wanes, ending TB as a global health threat is a critically important goal,” said Ditiu. 

New innovations 

“We have new innovations now to help us save lives—new diagnostic tools, shorter, less toxic treatment regimens, and new digital tools—and when we add the political muscle that the UNHLM will gather to the many dedicated health care professionals already in the front lines, ending TB looks increasingly possible,” she added.

These innovations include:

  • Rapid molecular tests that can identify TB and resistance patterns in the bacteria;
  • Shorter treatment regiments, for drug-sensitive and drug-resistant infections;
  • New digital tools, such as AI enabled ultraportable X-ray systems for screening for TB; 
  • Vaccine candidates that have advanced to phase 3 clinical trials.

Globally, investments in TB research and development have started to climb, surpassing US$1 billion for the first time ever. 

TB advocates hope that the coming High Level Meeting will propel governments and other funders to attain the US$2 billion per year investment goal pledged by countries at the first High Level Meeting in 2018, with a roadmap for increasing funding to US $5 billion per annum as envisioned by the Global Plan to End TB

They cite new data that shows every US$1 invested in TB yields US$46 in benefits.

 “What we need is quite simple, given that TB kills 1.6 million people every year,” added Ditiu. “We need increased political commitments from all high TB burden countries, and significantly more financing so that we can meet new challenges and embark upon a much faster path to new vaccines. We know what it takes to end TB; we need to roll up our sleeves and make it happen.”

India’s model system 

Mansukh Mandaviya, Minister of Health, India, describes country’s advances in TB diagnosis and treatment.

India’s model system combines digital health tools, economic incentives,  and old fashioned social support systems with a facelift.  

A real-time TB information system called NIKSHAY, triggers direct cash transfers to TB patients who continue their treatments. In the last five years, using this system, US$260 million has been disbursed to nearly 8 million people with TB to support their nutrition, Indian officials say. 

“Under the Prime Minister’s TB Free India Campaign, launched in September 2022, nearly 1 million people with TB have received commitments from individuals in society who will support them through their treatment journey,” said Suvanand Sahu, the deputy executive director of the Stop TB Partnership. 

“This initiative is unique in the world and is a great intervention for TB awareness, stigma elimination, community ownership and crowdfunding.”

At the same time, responsibility for implementing the campaign has been decentralized to state, district and village levels, with awards given to recognize states and districts who are making rapid progress towards ending TB. 

“TB Champions” also are recognized for their contributions to end TB in their community. Currently more than 30,000 TB Champions are supporting the TB response in India.

“India is providing models to fight TB. Trace, Test, Track, Treat and Technology is the strategy we are implementing to end TB in India by 2025,” said Modi in his keynote address.  

India also ramping up generic production of improved TB treatment  

At a separate press briefing on Thursday, WHO said it was also extending a TB Flagship Initiative for another five years- as new, promising TB vaccines approach market approval stage. 

WHO will establish a TB Vaccine Acceleration Council to spur movement on promising vaccine candidates, said WHO Director General Dr Tedros Adhanom Ghebreyesus at the briefing. 

“The only TB vaccine developed to date, the BCG vaccine, is more than 100 years old, and does not adequately protect adolescents and adults, who account for most TB transmission,’ he said, adding the new Council would “facilitate the development, licensing and use of new TB vaccines.

WHO welcomes India’s removal of patent from TB drug bedaquiline

Tereza Kasaeva, WHO Assistant Director, and head of the global TB programme.

Speaking at the press briefing  Dr Tereza Kasaeva, WHO Assistant Director-General, said “we are very optimistic about having new vaccines. There are about 16 vaccine candidates in the pipeline and at least one of the vaccines at the Phase III clinical trial stage is showing efficacy at least 50%. 

BioNTech has also identified a promising mRNA TB vaccine candidate, with Phase 1 trials due to begin soon, she reported, adding:  “If it will go the right way, quite soon, we may have new, effective TB vaccines.  

Kasaeva also welcomed the Indian Patent Office’s rejection of Johnson & Johnson’s request to  extend the patent on a critically important TB drug, Bedaquiline, which is set to expire in July. 

The decision opens the way for generic manufacture of the TB drug at far reduced prices; the drug currently costs about US500 a year in India. As India is the world’s leading TB drug producer, generic manufacturer will increase the flow of cheaper generics to many other low and middle income countries.     

The pharma company had sought to extend the patent, originally granted in 2008, until 2027, under a slightly new formulation – a tactic described as “evergreening” to prolong a patent’s lifespan. 

“As you know, Janssen Pharmaceuticals [a J&J subsidiary] has a monopoly over Bedaquiline, one of the most effective drugs for the treatment of drug resistant TB,” Kasaeva said. “And this monopoly will continue until July 20, 2023. The generic manufacturers are quite ready to enter the market with quality-assured tablets of Bedaquiline. So that’s why from that point of view, we are considering this news as positive.”

Image Credits: Stop TB Partnership, Stop TB Partnership.

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