Tuberculosis cases and deaths have increased for the first time in decades, and fewer cases were detected and fewer people treated during 2021 – all as a result of disruptions caused by the COVID-19 pandemic, according to the World Health Organization (WHO).

An estimated 10.6 million people fell sick with TB last year, an increase of 4.5% from 2020, while 1.6 million people died, according to the WHO’s  2022 Global TB report released on Thursday. 

Drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB recorded in 2021. DR TB is harder and more expensive to treat.

The TB incidence rate (new cases per 100 000 people per year) also rose by 3.6% between 2020 and 2021 – reversing declines of about 2% per year for most of the past 20 years.

An increase in deaths from TB between 2019 and 2021 also reversed a decline in mortality that started in 2005. 

“Globally, the reduction in the total number of TB deaths between 2015 and 2021 was less than 6%, about one-sixth of the way to the milestone of 35%,” Dr Tereza Kasaeva, director of WHO’s Global TB Programme, told a media briefing on Thursday.

Eight countries accounted for more than two-thirds of the global total of cases: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo.

“The largest burden of TB was in the WHO Southeast Asian region, 46%, followed by the WHO African region, 23%, and the WHO western Pacific, 18%,” according to Kasaeva.

“Growing rates of poverty, inequity, under-nutrition and other comorbidities, as well as discrimination and stigma, are the major drivers of the TB epidemic,” she added.

“Globally in 2021, of the 10.6  million people who fell ill with the TB, an estimated 2.2 million were attributable to undernourishment and another 2.6 million jointly to other main risk factors such as HIV infection, alcohol use disorders, smoking and diabetes. 

“HIV, poverty and under-nutrition are driving TB in Africa,” she added, also noting a cut in global spending on TB services “from $6 billion in 2019 to $5.4 billion in 2021”, which is less than half the global target of $13 billion annually by 2022.

Short on funds

As in the previous 10 years, most of the funding used in 2021 (79%) was from domestic sources. In low- and middle-income countries, international donor funding remains crucial. The main source is the Global Fund to Fight AIDS, Tuberculosis and Malaria, while the US contributes close to 50% of international donor funding for TB – via Global Fund donations and bilateral aid.

“USAID has been the leading bilateral donor of the international fight for TB,” said Dr Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID).

“We have spent $4.2 billion since 2000 on this on this effort… 10.6 million people each year get TB and 1.6 million die each year. This is something that we shouldn’t see in our lifetime. We should be able to end TB in our lifetime,” added Vincent.

“This is a very important moment to have this data and reflect on what can we do more how can we recover…. from COVID, mitigate COVID impact on TB but also to end TB.” 

Kate O’Brien, a US TB survivor and advocate for ‘We Are TB’, stressed that ”when we hear numbers like this, sometimes it can be kind of difficult to remember that every single one of those numbers is a person, with a family”. 

“When I had tuberculosis myself, I was in pain. I was terrified, and I was also worried that I was going to lose my baby because I was pregnant. I was going from doctor to doctor and I just couldn’t get a sense of urgency. I didn’t become diagnosed with tuberculosis until I was in an ICU, until my lungs were very, very poorly damaged. And that sense that lack of a sense of urgency really almost cost me and my child our lives.”

Fewer tests, and fewer on treatment

Only 5.8 million new TB cases were detected in 2020, whereas 7.1 million were found in 2019, indicating a drop in testing rather than in new cases. There was a partial recovery to 6.4 million in 2021, but this was still “well below pre-pandemic levels”, the WHO notes.

By 2021, the world was only two-thirds of the way to reaching the global target of treating 40 million people in five years (2018- 2022), with only 26.3 million having been treated.

“The report provides important new evidence and makes a strong case on the need to join forces and urgently redouble efforts to get the TB response back-on-track to reach TB targets and save lives,” said Kasaeva. “This will be an essential tool for countries, partners and civil society as they review progress and prepare for the second UN High Level Meeting on TB mandated for 2023.”