The COVID-19 pandemic has led to a U-turn in years of global progress in tackling tuberculosis and for the first time in over a decade, TB deaths have increased, according to a new report by the World Health Organization.
The WHO’s 2021 Global TB report found that last year, more people died from TB, with far fewer people being diagnosed and treated or provided with TB preventive treatment compared with 2019, and overall spending on essential TB services falling.
Despite the global figures, cases of TB – a bacterial infection that affects the lungs - fell in many Gulf states, the report revealed.
Saudi Arabia – which has reported a consistent decline in cases of TB over the past decade – has an incidence rate of about 2,800 among its 34.8million population and are 100 percent on antiretroviral therapy.
In the United Arab Emirates, there are just fewer than 100 people estimated to be living with TB and reported zero deaths linked to the disease last year. Similarly, 100 percent of TB patients are on antiretroviral therapy.
On the latest WHO report, the organization said the first challenge in keeping the global progress in tackling tuberculosis is disruption in access to TB services and a reduction in resources.
In many countries, human, financial and other resources have been reallocated from tackling TB to the COVID-19 response, limiting the availability of essential services.
The second is that people have struggled to seek care in the context of lockdowns.
“This report confirms our fears that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis,” said Dr. Tedros Adhanom Ghebreyesus, WHO director-general. “This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.”
TB services are among many others disrupted by the COVID-19 pandemic in 2020, but the impact on TB has been particularly severe.
For example, approximately, 1.5 million people died from TB in 2020.
The increase in the number of TB deaths occurred mainly in the 30 countries with the highest burden of TB. WHO modeling projections suggest the number of people developing TB and dying from the disease could be much higher in 2021 and 2022.
Challenges with providing and accessing essential TB services have meant that many people with TB were not diagnosed in 2020. The number of people newly diagnosed with TB and those reported to national governments fell from 7.1 million in 2019 to 5.8 million in 2020.
WHO estimates that some 4.1 million people currently suffer from TB but have not been diagnosed with the disease or have not officially reported to national authorities.
This figure is up from 2.9 million in 2019.
The countries that contributed most to the global reduction in TB notifications between 2019 and 2020 were India (41 percent), Indonesia (14 percent), the Philippines (12 percent) and China (8 percent). These and 12 other countries accounted for 93 percent of the total global drop in notifications.
There was also a reduction in provision of TB preventive treatment. Some 2.8 million people accessed this in 2020, a 21 percent reduction since 2019. In addition, the number of people treated for drug-resistant TB fell by 15 percent, from 177,000 in 2019 to 150,000 in 2020, equivalent to only about one in three of those in need.
Global investment for TB falls
Funding in the low and middle-income countries (LMICs) that account for 98 percent of reported TB cases remains a challenge. Of the total funding available in 2020, 81 percent came from domestic sources, with the BRICS countries (Brazil, Russian Federation, India, China and South Africa) accounting for 65 percent of total domestic funding.
The largest bilateral donor is the US government. The biggest international donor is the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The report notes a fall in global spending on TB diagnostic, treatment and prevention services, from $5.8 billion to $5.3 billion, which is less than half of the global target for fully funding the TB response of $13 billion annually by 2022.
Global TB targets off track
Reversals in progress mean that the global TB targets are off track and appear increasingly out of reach, however there are some successes. Globally, the reduction in the number of TB deaths between 2015 and 2020 was only 9.2 percent - about one quarter of the way to the 2020 milestone of 35 percent.
Globally, the number of people falling ill with TB each year (relative to population) dropped 11 percent from 2015 to 2020, just over half-way to the 2020 milestone of 20 percent.
However, the WHO European Region exceeded the 2020 milestone, with a reduction of 25 percent. This was mostly driven by the decline in the Russian Federation, where incidence fell by six percent per year between 2010 to 2020. The WHO African Region came close to reaching the milestone, with a reduction of 19 percent, which reflects reductions of 4–10 percent per year in South Africa and several other countries in southern Africa.