TB progress set back a decade by COVID-19 – WHO

Ruth Douglas and Gareth Willmer

More than half a million people may have died last year as a result of reductions in TB diagnosis and care, setting back progress towards ending the disease by a decade, the World Health Organization (WHO) estimates.

About 1.4 million fewer people received care for tuberculosis in 2020 than in 2019, as resources were diverted to fighting COVID-19, according to provisional WHO data from 84 countries, released ahead of World TB Day (24 March).

Lockdowns and reassignments of health staff and equipment have had a “severe impact” on essential TB services, according to a WHO report on the effects of the global pandemic on TB detection and mortality.

“We need to seize the shock of COVID, which has made the world have a rethink about the threat of infectious diseases, to reset the way the world thinks about TB,”

Peter Sands, executive director, Global Fund to Fight AIDS, Tuberculosis and Malaria

The 84 countries reported 4.9 million cases in 2020 compared with 6.3 million in 2019 -­ a reduction of 22 per cent. The largest shortfalls were in Indonesia (42 per cent), South Africa (41 per cent), Philippines (37 per cent) and India (25 per cent).

WHO director-general Tedros Adhanom Ghebreyesus said: “The effects of COVID-19 go far beyond the death and disease caused by the virus itself. The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the world’s poorest people, who were already at higher risk for TB.”

Monthly case notifications in the four countries with the largest reported shortfalls in case notifications in 2020, compared with the average level of 2019 (blue dashed line). Source: WHO – Impact of the COVID-19 pandemic on TB detection and mortality in 2020.

Lucica Ditiu, executive director of the Stop TB Partnership told a virtual press briefing last week: “It means that we lose a lot from what we achieved. We came a long way and were very proud of where we were in 2019 and 2018.

“To get back to where we were supposed to be without COVID, it means that we not only need to recover the ground we lost in 2020, but also go beyond that.”

Two diseases, one solution

Ditiu highlighted data from India and South Africa showing that people who contract both TB and COVID-19 have a mortality rate three times higher than those infected with TB alone. She stressed the need to address the two diseases in tandem, noting parallels in possible measures to diagnose and curb the spread of each.

“If we are smart and we invest in these kinds of measures, we will not help only TB or COVID, we will help both diseases ­ and we will also strengthen our system to be able to address any future airborne pandemic diseases,” she added.

Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said that while COVID-19 killed about 1.8 million people worldwide in 2020, TB may have caused close to the same number of deaths. If the disease is not properly addressed, he added, it could create another “future risk for humanity” in the form of multidrug-resistant TB.

“We should challenge ourselves: why is it that we have left people behind, that we haven’t finished the fight against TB as an older pandemic?” he said. “We need to seize the shock of COVID, which has made the world have a rethink about the threat of infectious diseases, to reset the way the world thinks about TB.”

Stepping up diagnosis

The WHO called for urgent improvements in screening to rapidly identify people with TB infection, including the use of molecular rapid diagnostic tests, computer-aided detection to interpret chest radiography, and TB screening for people living with HIV.

Harsh Vardhan, minister of health for India and newly appointed chair of the Stop TB Partnership board, said that lessons could be learned from India, which has the world’s highest TB burden.

He said the country had developed a detailed rapid response plan to mitigate the impact of COVID-19 on TB services in the country, with bi-directional screening used to aid tracking of both diseases. The country’s national TB elimination programme has ramped up its diagnostic capacity, while harnessing community-led monitoring initiatives and home drug delivery.

“When it comes to fighting TB, India has much to share with the global audience in terms of strategies and policies, implementation challenges and their solutions,” said Vardhan.

Joanne Carter, vice-chair of the Stop TB Partnership board, urged governments to scale up funding despite the strain on budgets. Focusing on both diseases could provide a “win-win” for everyone, she said.

“We can’t force a false choice between fighting COVID or fighting TB,” said Carter. “Communities, individuals and health systems are facing both these challenges, and they have to have the financial and human resources to respond.”

Ruth is responsible for managing the content of SciDev.Net’s global edition, and acts as deputy managing editor. Before joining the team in March 2019 she worked for eight years as a journalist and online news editor with the international news agency Agence France-Presse. Ruth has a degree in French and German from the University of Edinburgh and a postgraduate diploma in journalism.