Are we ready to give it all to #endTB?

Shobha Shukla / Bobby Ramakant *

First-ever United Nations High Level Meeting to end TB by 2030 was held four years ago. It culminated in an important political declaration that galvanised accelerated action towards eliminating TB by 2030. With less than a year to deliver on intermediary 2022 promises, progress has been there but dismal.

More importantly, latest Global Tuberculosis (TB) Report of the World Health Organization (WHO) shows that COVID-19 gave a major jolt to the efforts to fight the ancient disease forcing to reverse gains that were made in the past decade.

For the first time in over a decade, TB deaths have increased because of reduced access to TB diagnosis and treatment in the face of the COVID-19 pandemic. Close to half of the people ill with TB missed out on access to care in 2020 and were not reported; also, the number of people provided with treatment for drug-resistant TB and TB preventive treatment dropped significantly.

"TB rates are not declining as steeply as we need to end TB by 2030. Goal of a world free of endemic transmission of TB and without disability and death due to TB is achievable as it has already been achieved in some nations like Australia. We need to convert high burden countries into low burden countries as soon as possible,” said Prof Guy Marks, President of the International Union Against Tuberculosis and Lung Disease (The Union) and noted respiratory medicine expert and lung health epidemiologist-researcher of University of New South Wales, Australia.

Prof Marks was speaking at Asia Pacific regional press conference hosted by The Union and Asia Pacific Cities Alliance for Health and Development (APCAT).

It is important to note that despite unprecedented progress towards #endTB goal in the past decade, most parts of the world were not on track to end TB even before the COVID-19 pandemic. Decline in TB rates every year were much lower than the desired rate if we are to end TB by 2030. Undoubtedly, COVID-19 had a devastating blow to the efforts to end TB.

Is TB everyone's business?

“We are struggling to be in the correct direction to #endTB because TB is not yet everyone’s business. Stigma is still there for instance,” said Dr Erlina Burhan, Head of TB Assembly, and Chairperson of the Indonesian Lung Doctors Association (PDPI) and member, Board of Directors, The Union. Importantly, she said there is a silver lining in the COVID-19 pandemic, as many of the health protocols to protect people from the new virus, such as testing, tracing, hand-washing and social distancing, also protect people from TB.

“We have to make sure these important infection prevention practices are also reinforced in the fight against TB. COVID-19 has shown how quickly progress can be made in the fight against a deadly infectious disease when the world joins forces. With COVID-19, everything was developed in a very short time – in less than a year we had a vaccine. I think we can do it for TB as well – now is the time.”

Preventing TB is essential along with TB treatment, care and support

Latent TB infection is when a person is infected with TB bacteria, but has no symptoms, is not sick and cannot infect anyone else. But there is a risk that one-tenth of these people with latent TB may progress to active TB disease. Every case of active TB disease comes from an individual with latent TB infection.

That is why all governments in the first-ever United Nations High Level Meeting (HLM) to #endTB in 2018 promised to advance progress in treating latent TB too. We have just one year to meet the 2022 goals set in this UN meet. Next UN HLM on TB is slated to be held next year.

“About one quarter of the world’s population is infected by the TB bacilli (latent TB). In time, 10% of these patients may get the active TB disease. To bring down the TB disease in the world, it is very important to identify these patients with latent TB and those with high risk to develop TB disease in the future and treat them for latent TB by providing them TB preventive therapy,” said Prof Abdul Razak Mutttalif, Senior Consultant Chest Physician, Head of Medicine, MAHSA University, Malaysia.

TB and Tobacco smoking: a deadly combination

“Tobacco use not only increases risk of progressing from latent TB to active disease, but also delays diagnosis, worsens treatment outcomes, and increases risk of untimely death. In the context of the COVID-19 pandemic, multisectoral action to address tobacco smoking and other determinants of TB is more important than ever. Governments are required to invest in tobacco control policies and have to walk the talk on multisectoral accountability to end TB.

More importantly, along with UN High Level Meeting to end TB with heads of our governments, we also need to equally engage local leaders whose role in translating global promises into local actions is essential,” said Dr Tara Singh Bam, Asia Pacific Regional Director of The Union.

TB remains the top infectious killer worldwide. In 2020, an estimated 10 million people fell ill with TB worldwide. WHO estimated, a total of 1.5 million people died from TB in 2020 (including 214 000 people with HIV). As per WHO, many new cases of TB are attributable to five risk factors: undernutrition, HIV infection, alcohol use disorders, smoking and diabetes. People who smoke are 1.6 times more at risk. Globally in 2020, there were 0.73 million new TB cases that were attributable to smoking.

The pandemic has reversed gains and set back the fight against TB by several years. We need to multiply our efforts and investments to urgently close the widening gaps in access to much-needed prevention and care for millions affected by this ancient disease as well as address all related risk factors, social and commercial determinants.