On Friday 24th March 2023 the WHO and other organisations and individuals observe ‘World Tuberculosis Day’ with the theme “Yes! We can end TB!”. This uplifting and emphatic statement is intended to “inspire hope” and encourage action among leaders.
In particular, 2023 is a “critical” year, with opportunities for “visibility and political commitment” offered at the 2023 UN High-Level Meeting on TB. WHO’s “spotlight” for this year will be “urging countries to ramp up progress” as we get closer to this meeting. World TB Day is observed annually on 24th March as this marks the day in 1882 when the TB-causing bacterium was discovered.
What is TB and why are we still fighting?
TB is described by WHO as “one of the world’s deadliest infectious killers”, claiming the lives of “close to 4,400 people” every day. Caused by Mycobacterium tuberculosis, it most commonly affects the lungs and is spread from person to person through the air. Although TB is found across the globe, the largest number of new cases in 2021 occurred in the WHO South-East Asian Region, with 46% of new cases.
As TB is “preventable and curable”, efforts to this end have saved up to 74 million lives since 2000. However, we continue to experience devastating infections and deaths. Most recently, the COVID-19 pandemic has caused major disruptions to global efforts against other diseases, and this has combined with “conflicts” and “socioeconomic inequities” to undo years of progress. Indeed, WHO recently highlighted that “for the first time in over a decade, estimated TB incidence and deaths have increased”.
When we spoke to Dr Mark Feinberg about why this has happened, he offered an interesting insight into how we as humans respond to threats. He suggests that “if you have a problem and it’s there for a long time, and it’s hard to deal with, you tend to try and ignore it and put it in the back of your mind”. Dr Feinberg argues that for TB, as with other infectious diseases, media attention may have slipped but progress continues to be made by researchers.
Missing key goals
In an article in The Lancet in March 2023, authors Dr Tereza Kasaeva, Hannah Monica Dias, and Dr Madhukar Pai wrote about the importance of meeting the “ambitious targets” from previous UN meetings that have been missed.
For example, treatment goals were identified in 2018 for countries to treat an “additional 40 million” people with TB and provide preventative treatment to “at least 30 million people at risk” by 2022. However, between 2018 and 2021, 26.3 million were treated. This is “still far short of the 40 million. Furthermore, the number of people provided with preventative treatment was “12.5 million”, again “still far from the target”. Why is this?
Disruptions and devastation
The authors identify the “health-care disruptions due to the COVID-19 pandemic” as a key factor. In addition, conflicts and “widening socioeconomic and health inequities” have been “devastating” for TB care.
“As sobering as this news is, it is important to find hope and keep the fight going.”
Turning the TB tide
The paper does identify “reasons for optimism”. Through a combination of “high-level leadership, increased investments, faster uptake of new WHO recommendations and adoption of innovations, accelerated action, and multisectoral collaboration” the authors identify potential to “turn the tide” on TB.
“2023 will be a crucial year.”
As we continue to engage with lessons learnt through the COVID-19 pandemic, we can exploit the “remarkable investments” made across the countermeasure spectrum.
“It is time to develop and scale new vaccines for tuberculosis, and the case for investment is strong.”
The authors state that COVID-19 vaccine development platforms could be “leveraged and deployed” for TB vaccines to “enormous” effect.
Priorities for partners
The paper also offers ten priorities that require a “unified response across sectors and partners” to “fast-track the fight” against TB.
- Enhancing high-level leadership and advocacy to prioritise ending tuberculosis driving down deaths and ending suffering.
- Strengthening multisectoral engagement and accountability to address the upstream and wider health and social determinants of tuberculosis.
- Urgently increasing funding for essential tuberculosis services, including the health workforce.
- Substantially increasing investments in tuberculosis research to drive technological breakthroughs, such as vaccines and the rapid uptake of innovations.
- Advancing universal health coverage and integration of efforts to end tuberculosis into primary health care to ensure all people with tuberculosis have access to affordable quality care while strengthening health systems and engaging all providers.
- Addressing the drug-resistant tuberculosis crisis, with a focus on roll-out of WHO-recommended universal drug susceptibility testing and shorter, all-oral, injectable-free treatment to close persistent gaps in care.
- Markedly scaling up provision of preventative treatment for tuberculosis, especially for household contacts.
- Ensuring meaningful engagement of civil society, communities, and people affected by tuberculosis.
- Promoting human rights and combating stigma and discrimination.
- Aligning with the ongoing efforts on pandemic preparedness to proactively tackle future disruptions to tuberculosis services through key partnerships and collaborations for better efficiency and synergy, particularly at the country level.
“Although the COVID-19 pandemic has been a massive setback for progress in ending tuberculosis, it has shown us that nothing is impossible if we set our minds to it and make the necessary investments.”
“We must be bold enough to imagine a world where people with tuberculosis receive humane and quality care wherever they are and have access to the best tools we have and where tuberculosis finally gets the budget and political attention we need to end this great plague.”
We will hear more from experts like Dr Mark Feinberg on diseases that have been “neglected” during the COVID-19 pandemic at the World Vaccine Congress in Washington, so join us by getting your tickets here.
