Professor Guy Marks
President and Interim Executive Director of the International Union Against Tuberculosis and Lung Disease
Those of us working to end tuberculosis—like COVID-19, an airborne, primarily respiratory illness—know too well how disadvantaged and vulnerable communities are more severely affected by infectious diseases.
Vulnerable and disadvantages communities suffer more of the direct effects of ill-health and premature death. They’re also face more indirect effects, including catastrophic costs of receiving healthcare and loss of employment or income that plunges them into poverty.
The socioeconomic divide
Virtually no one in wealthy countries expects to die from tuberculosis. Yet pre-COVID-19, TB was the world’s leading cause of death from an infectious disease. TB killed 1.4 million people in 2019. More than 95% of those deaths occurred in low- and middle-income countries according to WHO.
Our experience from TB also tells us that without a deliberate and internationally guaranteed plan to ensure equitable access to the tools needed to prevent, find, diagnose and treat the disease, backed by adequate resources, we will fail. We will quickly see some countries gain access to the latest scientific advancements while others suffer without.
We are seeing this play out with startling effect with COVID-19 vaccines. Vaccines are being discarded in the U.S., while in many countries in Africa, less than 1% of people are fully vaccinated—with frontline health workers still waiting for their first dose.
Virtually no one in wealthy countries expects to die from tuberculosis. Yet pre-COVID-19, TB was the world’s leading cause of death from an infectious disease.
Ensuring affordable access to medicines
Many in the TB community fear that as COVID-19 eventually retreats from the rich countries but remains a major problem in poorer countries, it will recede from their public consciousness, as has happened with TB. If that occurs, the focus on affordable access to vaccines and other tools will wane. COVID-19 will become one more disease that continues to kill and incapacitate large numbers of people in developing countries.
Tackling inequalities
This inequity is clearly unjust. However, there are also reasons of self-interest why wealthy countries must step up their contributions to the global response. COVID-19 is a highly infectious disease. It cannot be constrained by international borders.
The lack of political will to end TB has led to the spread of drug-resistant TB, which has become a worldwide health crisis. Similarly, the unmitigated spread of COVID-19 in some countries would put the global response at risk of failure, making the whole world less safe by increasing the generation of variants of concern.
The parallels between COVID-19 and TB are alarming. Until we get serious about equity in the response to COVID-19, the disease will remain a threat to us all.