Prior to the COVID-19 pandemic, many countries were making steady progress in tackling tuberculosis (TB), with a 9% reduction in incidence seen between 2015 and 2019 and a 14% drop in deaths in the same period. High-level political commitments at global and national levels were delivering results. However, a new report from WHO shows that access to TB services remains a challenge, and that global targets for prevention and treatment will likely be missed without urgent action and investments.
Approximately 1.4 million people died from TB-related illnesses in 2019. Of the estimated 10 million people who developed TB that year, some 3 million were not diagnosed with the disease, or were not officially reported to national authorities.
The situation is even more acute for people with drug-resistant TB. About 465 000 people were newly diagnosed with drug-resistant TB in 2019 and, of these, less than 40% were able to access treatment. There has also been limited progress in scaling up access to treatment to prevent TB.
“Equitable access to quality and timely diagnosis, prevention, treatment and care remains a challenge,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “Accelerated action is urgently needed worldwide if we are to meet our targets by 2022.”
About 14 million people were treated for TB in the period 2018-2019, just over one-third of the way towards the 5-year target (2018-2022) of 40 million, according to the report. Some 6.3 million people started TB preventive treatment in 2018-2019, about one-fifth of the way towards the 5-year target of 30 million.
Funding is a major issue. In 2020, funding for TB prevention, diagnosis, treatment and care reached
US$ 6.5 billion, representing only half of the US$ 13 billion target agreed by world leaders in the UN Political Declaration on TB.
The COVID-19 pandemic and TB
Disruptions in services caused by the COVID-19 pandemic have led to further setbacks. In many countries, human, financial and other resources have been reallocated from TB to the COVID-19 response. Data collection and reporting systems have also been negatively impacted.
According to the new report, data collated from over 200 countries has shown significant reductions in TB case notifications, with 25-30% drops reported in 3 high burden countries – India, Indonesia, the Philippines – between January and June 2020 compared to the same 6-month period in 2019. These reductions in case notifications could lead to a dramatic increase in additional TB deaths, according to WHO modelling.
However, in line with WHO guidance, countries have taken measures to mitigate the impact of COVID-19 on essential TB services, including by strengthening infection control. A total of 108 countries – including 21 countries with a high TB burden – have expanded the use of digital technologies to provide remote advice and support. To reduce the need for visits to health facilities, many countries are encouraging home-based treatment, all-oral treatments for people with drug-resistant TB, provision of TB preventive treatment, and ensuring people with TB maintain an adequate supply of drugs.
“In the face of the pandemic, countries, civil society and other partners have joined forces to ensure that essential services for both TB and COVID-19 are maintained for those in need,” said Dr Tereza Kaseva, Director of WHO’s Global TB Programme. “These efforts are vital to strengthen health systems, ensure health for all, and save lives.”
A recent progress report from the UN Secretary General outlines 10 priority actions for Member States and other stakeholders to close gaps in TB care, financing and research, as well as advance multisectoral action and accountability, including in the context of the COVID-19 pandemic.