The World Health Organization’s (WHO) recently released Global Tuberculosis Report for 2021It paints a grim picture of the negative impact that the COVID-19 epidemic has had on the fight to eradicate TB worldwide.
To achieve the 2030 elimination target, progress against TB has been slow. But, before the pandemic, the world was making steady progress towards diagnosing and treating TB. The number of TB-related deaths has steadily declined each year since 2005.
Based on responses to WHO from 197 countries, the report was created. It represents around 99% of the world’s population and TB cases and provides annual feedback to the national and international public health community.
This year it contains very worrying news about the COVID-19 pandemic’s wide-ranging and longer term effects on TB services.
For the first year since 2005, the number deaths from TB has increased from one year of the previous. 2020 saw 1.3 million deaths in HIV-negative people, and 214,000 in HIV-positive people. In 2019, the death toll was 1.2 million for HIV-negative people and 209,000 for HIV-positive.
Mathematical modelling projectionsThe 16 countries most affected, including South Africa are most likely to see a worsening of the knock-on effect in 2021 and beyond. These countries will likely experience even greater increases in the number and death from TB.
According to the report’s top priority is to restore access to and provide TB services. This will enable TB cases to be detected early and treatment to resume pre-pandemic levels. To address the priority areas, countries will need to invest in research and innovation over the longer term. These include: TB vaccines to reduce infection risk and disease risk in those already infected; rapid diagnostics that can be used at the point-of-care; and shorter, simpler treatments for TB disease.
Why Gains in TB Control have been Reversed
All health services have suffered from the negative effects of COVID-19. The impact on TB services was profound. This is especially the case with regard to TB diagnosis — the essential first step to treating TB and preventing death.
Between 2017 and 2019, the number of people diagnosed with TB has increased each year. However, there was a shocking drop of almost 20% between 2019-2020, from 7.1 million to 5 million. However, the number of TB related deaths has increased by around 10%, bringing it back to 2017 levels.
In the 2021 Report, 16 countries accounted to 93% of global new TB diagnosis drops of 1.3million. India, Indonesia, Philippines were the most affected. These three countries are part of a group of 10 countries, including South Africa. They are considered high-burden for drug resistant, drug sensitive and HIV-associatedTB.
The new data showsThe gap between reality and goals in countries with high burden has widened.
Many negative consequences have resulted from the COVID-19 epidemic for TB services.
The report notes these three:
- Patients have been unable to access care due to restrictions on their movement.
- Resource constraints have reduced the likelihood of diagnosis
- Due to stockouts and medicine supply interruptions, treatment initiation is reduced.
Models of future impact could also be underestimated, because they don’t account for the negative effects COVID-19 has on social determinants of TB. People already infected by TB have a higher chance of developing the disease if they are low-income and malnourished. Mycobacterium tuberculosisTB is an infectious agent.
Trend will continue unless the world acts now
Untreated TB cases are more likely to be undiagnosed. This will increase the likelihood of TB transmission. further increase in TB disease and deathWithout action, the years ahead will be long and difficult.
TB preventive treatment can be given to those who are at high risk for developing TB disease after being infected. Mycobacterium tuberculosis. The WHO recommendsIt is important that TB preventive treatment be given to HIV-positive people, household contacts of people diagnosed with TB of their lungs, and certain co-morbidities like dialysis or diabetics.
In the last 18 months, there have been setbacks for services that provide TB prevention treatment. Globally, the number who received TB prevention treatment increased by 250% between 2015-2019. This trend was reversed in 2020, with a 21% decrease from 3.6 million to 2.5 million. Substantial resources and action must be directed at the provision of TB prevention treatments to those who meet the criteria.
A six-month course is the standard of care in drug sensitive TB diseases. The report also shows that 36 countries have adopted the newly recommended treatment. shorter treatment regimens for drug susceptible TB.
TB is the leading cause of death among HIV-positive people. In 2020, the absolute number of people with TB who were aware of their HIV status dropped by 15%. However, the global coverage of HIV testing for people with TB remained high in 2020. Between 2000 and 2020, 66,000,000 deaths were prevented by treatment of TB and the provision of ARVs to HIV-positive individuals diagnosed with TB.
The first South African National Prevalence surveyOther emerging researchIt has been shown that only half the people with active TB diseases report having symptoms such as fever, night sweats, cough, weight loss, or weight gain.
This means that people in the early stages or active TB disease may not be aware of their role in TB transmission. It is crucial that COVID-19 setbacks are addressed, including catch-up campaigns for case-finding, treatment, and other methods to identify people with TB without symptoms.
It is quite shocking to consider that during the COVID-19 pandemic 18 months, approximately 90,500 South Africans have died of TB – more than the 88,754 reportedTo have died from COVID-19 during that same period. The COVID pandemic proved that health systems can make drastic changes when necessary. It is time to fight TB with the same determination.
Indira Govender receives funding from Economic and Social Research Council (UK) and the National Institutes of Health (USA).
Alison Grant receives funding from the Economic and Social Research Council (UK), National Institute of Allergy and Infectious Diseases (USA), Bill and Melinda Gates Foundation, Wellcome Trust. She is affiliated with the South African TB and HIV Think Tanks.
Al Leslie receives funding from the National Institute of Allergy and Infectious Diseases (USA), the Wellcome Trust and the South African Medical Research Council.
Emily B. Wong receives funding from the National Institutes of Health (USA), the Bill and Melinda Gates Foundation and the Wellcome Trust. Members of her lab are funded by the African Academy of Science and the South African Medical Research Council.
Yumna Moosa receives funding from the South African Medical Research Council and the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE).