Professor Guy Marks
President and Interim Executive Director, International Union Against Tuberculosis and Lung Disease
End tuberculosis in high-burden countries. Adapt and implement evidence-based interventions to stop the spread of this deadly, but curable, disease.
The incidence of tuberculosis (TB) in countries with a high burden of this airborne disease is falling at a glacial pace. In 2022, 10.6 million people fell ill with TB and 1.3 million died — more deaths than from any other infectious disease.
Tuberculosis with no symptoms
Far too many people with TB remain undiagnosed and untreated, often because they do not experience or recognise symptoms and, therefore, don’t seek care. These people are infectious and transmit TB to others who then develop TB from these unrecognised exposures. It was the same with Covid-19, where much of the spread occurred from infectious people who had no symptoms.
Setting context and targeted approach
Some interventions deployed in high-burden countries are transferred from low-burden countries. This is not always appropriate. For example, targeting high-risk groups is effective in low-burden countries because, in those settings, most TB occurs in these groups. However, in high-burden settings, everyone is at risk of TB. Targeting selected ‘high-risk’ groups alone will leave most people with TB undetected and infectious.
In high-burden settings,
everyone is at risk of TB
Approach to stopping transmission
The current strategy for ending TB in high-burden countries is not working. We must change our approach, based on new evidence, to win the fight against TB. In high-burden settings, most people who develop TB have been infected within the last two years. This means reducing the rate of new TB infections can have a big impact on breaking the chain of transmission.
Most people with infectious TB in these settings do not have symptoms. A key intervention must be population-wide screening, regardless of symptoms. This will enable us to find the majority of people with TB. This was highly effective for Covid-19 and in the 1960s and 70s in the UK, Australia and other countries that successfully ended TB.
Paradigm shift in response
Such modifications will not end TB in isolation; a shift in mindset must accompany them. Another learning from Covid-19 is how well governments and the global population respond to public health measures when they understand the threat.
An issue is that TB is not perceived to be a great enough threat to warrant the urgency and priority achieved for Covid-19. We need to recognise that the current strategy is not working. We must take it upon ourselves to change our approach and make TB history.