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Infectious Diseases 2021

Years of investment in TB lost due to the COVID-19 pandemic

iStock / Getty Images Plus / alfexe

Dr Lucica Ditiu

Executive Director, Stop TB Partnership 

Tuberculosis (TB), an airborne infection, has killed over a billion in the past 200 years, more than any other infectious disease.  

In 2020 another new airborne infection, COVID-19, overtook TB as the leading cause of death among infections, but TB still killed more people than COVID-19 in low- and middle-income countries.  

Scaling up treatment 

In 2018, to accelerate progress towards ending TB, a United Nations High Level Meeting (UNHLM) was convened which led to a political declaration with bold targets to be achieved by 2022. Treatment was scaled up in 2018 and 2019 to unprecedented levels, reducing the number of untreated people with TB.  

In 2020, the COVID-19 pandemic disrupted TB services in high TB burden countries. Staff, health facilities and laboratories were diverted to COVID-19 response. People faced barriers in accessing TB services due to restrictions in mobility, fear and stigma. TB diagnosis dropped sharply in most high TB burden countries. Other areas of TB prevention and care, and TB research and development were also impacted.  

In May 2020, a modelling study by Stop TB Partnership predicted that due to the COVID-19 pandemic-related restrictions, the global TB incidence and mortality could increase, setting back the global fight against TB by five to eight years. In early 2021, on review of data from varying countries, the situation seems to be worse as TB diagnosis and treatment declined in 2020 by over 20% and reached levels last seen 12 years ago.

We need to build back a system that can defend against airborne respiratory infections.

Learning from the COVID-19 pandemic 

There is urgent need now for high TB burden countries to recover from this loss and progress further to reach the UNHLM targets. Lessons must be learnt from the COVID-19 pandemic. Countries will need massive scale up of testing and tracing for TB, integrating it with their COVID-19 responses and partnering with affected communities in providing access to care and reducing stigma and fear.  

Modern diagnostics and digital tools need to be used and research and development needs to be speeded up. For this to happen, political commitment and increased financing is a must. We need to build back a system that can defend against airborne respiratory infections: TB, COVID-19 and future airborne pandemics. 


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