Priorities in a pandemic: What’s next for access to TB care?

Dr Obinna Nnewuihe

Global Health and Pandemic Response Fellow, MedShr, the world’s leading discussion platform for doctors

The focus on the COVID-19 response could lead to a global setback of at least 5 to 8 years for other infectious diseases, resulting in over a million additional deaths from TB alone.

The declaration of a pandemic in March 2020 by the World Health Organisation (WHO) set off a chain of reactions. In rapid response, urgent measures were employed by countries, from restrictions in movements to border closures. Global health efforts were prioritised based on impact on halting spread of the virus.

While critical for responding to the acute challenge, some COVID-19 response efforts produced increased focus on the emergency at the detriment of other existing health concerns. One of such diseases that has been put on the back burner, despite its massive toll on human lives, is Tuberculosis (TB).

Global burden of TB

TB remains the leading infectious disease killer in the world, claiming over 1.4 million lives annually. The WHO reports that in 2019, 87% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for two thirds of the new TB cases: India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

Impact of COVID-19 on TB services

At the height of the first wave, many low- and middle-income counties scrambled to ramp up testing for COVID-19, with GeneXpert machines – predominantly used for TB diagnosis – repurposed to support the pandemic response in LMICs.

In the face of the current national health priorities hyper-focused on responding to the pandemic, the advocacy group Stop TB has estimated that a 3-month lockdown and a protracted 10-month restoration could lead to an additional 6.3 million cases of TB between 2020 and 2025, and an additional 1.4 million TB deathsduring this time, resulting in a global setback of at least 5 to 8 years.

Efforts towards improving TB care

The Sustainable Development Goals includes an ambitious target to end the scourge of TB by 2030. In 2018, the world convened the first ever High-Level Meeting on TB, to raise the profile on advocacy for the disease and review progress on the Global End TB Strategy. Despite the bold actions taken to date on TB, milestones on reducing incidence, improving diagnosis (over 3 million missed cases annually) and overall mortality are still being missed.

Driving political commitment is critical for raising both funding and the profile of TB, but beyond the commitments such as that made at the 2018 High-Level Meeting on TB, is a resolve to implement the recommendations agreed to by governments. TB will continue to be a challenge, especially for developing countries who are constantly under intense fiscal pressures to address multiple infectious diseases, now compounded by a pandemic.

TB and other Infectious Diseases must also be prioritised in LMICs

As COVID-19 vaccine rollouts gain momentum across the world, the WHO projects that LMICs may not be fully vaccinated till 2023. If poorer countries remain crouched under the burden of COVID-19 for years, recovery and prioritisation of pre-existing killers such as TB would continue to suffer. In pushing for an end to the pandemic, TB and infectious diseases must also be prioritised to achieve more resilient health systems, especially in developing countries.