Will new scientific breakthroughs spur the #endTB efforts?

Shobha Shukla *

Is it not a paradox if a preventable, diagnosable, treatable, and curable disease becomes a top killer? Till Covid-19 struck our world, Tuberculosis (TB) - a disease that can be prevented, diagnosed and treated - was the most deadly infectious disease worldwide. Covid-19 pandemic has also adversely impacted the fight against TB, as well as other diseases.

Not surprisingly, the latest Global TB Report 2021 paints a grim picture of the TB disease burden, with the Covid-19 pandemic acting spoilsport and further jeopardising the progress on all fronts of TB prevention, diagnosis, treatment, care and control.

Despite growing efforts spanning over several decades, most of the world was not able to satisfactorily prevent TB, prevent conversion of latent TB into active TB disease, diagnose the disease timely or put all those diagnosed on effective standard treatments - and most importantly, avert untimely deaths.

Why are we off-track on most TB targets?

During the Covid-19 pandemic, another global health threat that has become even more severe is of TB. We are off track on most of the global TB targets, such as, the goal to end TB by 2030 which is enshrined in the United Nations Sustainable Development Goals (SDGs), or the targets of the World Health Organization (WHO)'s End TB Strategy, or promises made in the 2018 Political Declaration of the UN High-Level Meeting on TB.

We missed to deliver on TB promises for 2020

The End TB Strategy milestones for 2015-2020 aimed at a 35% reduction in the number of TB deaths and a 20% reduction in the TB incidence. However, TB deaths and incidence have reduced by only 9.2% and 11% respectively during this period. The negative impacts on TB mortality and TB incidence in 2020 are expected to become much worse in 2021 and beyond.

Will new better tools to diagnose and treat TB, zoom us towards #endTB targets?

Concerted efforts at all fronts, including scientific breakthroughs, are crucial to break the chain and end TB by 2030. Providing a glimmer of hope, several advances in the field of TB care and control were presented during the recent virtual 52nd Union World Conference on Lung Health. Here is a glimpse of some of these exciting researches for TB diagnosis and treatment:

Short, all-oral treatment for Rifampicin-resistant TB

Bern Thomas Myanga, Medical Director of Nobel prize-winning Medicins Sans Frontieres (MSF or Doctors Without Borders), UK, and Chief Investigator of the TB-PRACTECAL Trial, reported results of the MSF-led first-ever multi-country, randomised, controlled clinical phase 2/3 study on the efficacy and safety of the all oral, 24-week BPaLM (bedaquiline, pretomanid, linezolid, and moxifloxacin) regimen against the standard of care treatment for rifampicin-resistant TB. The study was conducted at 7 sites across Uzbekistan, Belarus and South Africa.

The new treatment regimen was found to be safer and more effective for patients with rifampicin-resistant TB than the current accepted standard of care that lasts for 9 to 24 months. 89% of the patients in the BPaLM group were cured, compared to 52% in the standard of care group. Tragically four patients died from TB or treatment side effects in the control group, while there were no deaths or failures in the new regimen arm. In addition, study results showed that the new drugs lead to a significantly lower rate of major side effects, with 80% of patients avoiding any major side effects compared to 40% in the control group.

Genome sequencing to identify TB strains that are likely to become drug-resistant

A study done in Peru, used genome sequencing to effectively predict strains of drug-susceptible TB that were likely to develop drug resistance in future.

Whole-genome sequencing was performed on 3000 sputum of samples of all patients presenting with TB symptoms at health centres in Lima, Peru, over a period of 17 years. Whole-genome sequencing was performed on each of these samples-whether of drug-susceptible or of drug-resistant TB. The researchers looked at drug-susceptible bacteria and aimed to identify mutations that would increase the probability of a bacteria becoming resistant in the future.

Presenting the study data, lead author Arturo Torres Ortiz, a researcher from Imperial College London, shared that, "We looked for any signs in drug-susceptible bacteria that they will become resistant in future. We identified those 'signatures' and saw that once the bacteria acquires resistance to one antibiotic, it is more likely that they will keep acquiring resistance to other antibiotics. We found that if the bacteria become resistant to isoniazid then they are upto 15 times more likely to acquire further resistance to rifampicin. We identified specific polymorphisms that can be used to make a molecular test in the future to tell us whether this drug-susceptible bacteria will become resistant in the future. This could be a potential game changer for preventing multidrug-resistant TB (MDR-TB)."

"We found that isoniazid mono-resistance backgrounds have a much higher risk of acquiring further rifampicin resistance than susceptible backgrounds. Rapid molecular tests usually focus on rifampicin resistance, which means that isoniazid mono-resistance is missed. This result in amplification into multi-drug resistance. We thus recommend that rapid molecular tests also identify regions associated to isoniazid resistance conferring mutations.

The mutations confer “pre-resistance”. Monitoring these mutations could prevent the amplification of drug resistance in the population by targeting those bacteria more likely to become resistant”, he added.

Molecular testing for TB in children with severe pneumonia

Although TB in children commonly presents with symptoms mimicking pneumonia, its diagnosis is usually considered only if they have repeated antibiotic treatment failures or if symptoms have been present for long. Thus diagnosis of TB in kids is often missed or delayed, causing high mortality in them as they cannot access treatment because they are not diagnosed, said Dr Olivier Marcy, Research Director, University of Bordeaux. He was presenting the results of the TB Speed Pneumonia study on the yield of systematic TB molecular testing performed on nasopharyngeal aspirates and stool samples in children with severe pneumonia in countries with high TB incidence. The study investigated if offering systematic molecular testing for TB in all children with pneumonia is feasible and whether it will affect mortality.

The study was done on 1169 children aged upto 5 years, with WHO-defined severe pneumonia, enrolled in 15 hospitals from 6 high TB incidence countries- Cambodia, Cameroon, Côte d’Ivoire, Mozambique, Uganda, and Zambia.

“Unlike adults, children below age 5 are unable to expectorate to produce sputum for molecular testing. So one has to use easier sample collection methods. We collected stool samples and nasopharyngeal aspirate samples (that involve non-invasive methods). Although taking stool samples seem rather easy in children, it takes time to collect them and it is not as easy as the other option. We could collect nasopharyngeal aspirate samples in 97% children and stool samples in 81% children. Molecular testing of stool samples and nasopharyngeal aspirates was done using Gene Xpert Ultra. 8.0% of the children with severe pneumonia were diagnosed with TB in the intervention arm”, informed Marcy.

“These are important findings. Although we have more and more data that TB is frequent in children with pneumonia, the guidelines and clinical practices are not taking this information into consideration. So we need to have better tools to detect TB in this group. Getting nasopharyngeal aspirates from them is not difficult. So it is important to convince doctors around the world that they can use this technique to diagnose TB in children”, he emphasized.

Artificial Intelligence based automatic detection system to improve diagnostic accuracy for active TB

Scientists at Shenzhen Zhying Medical Imaging in Guangdong, China, have developed an automated detection system based on artificial intelligence (AI) for screening active TB disease on CT images.

They conducted a study to test the accuracy of this detection system that can automatically read DICOM CT images to diagnose active TB disease and also differentiate between TB and pneumonia. This AI-based system, followed with a self-organized clustering algorithm in the study was found to accurately diagnose active TB disease during its earlier stages, and distinguish between active TB disease and non-active TB (i.e. pneumonia and normal cases). It simplifies the diagnosis process and lays a solid foundation for AI in CT diagnosis of active TB disease in a large-scale clinical application.

The sensitivity and specificity for artificial intelligence are very high (0.935 and 0.971 respectively), which show that the AI-tool performs well for diagnosis of active TB disease and differential diagnosis of active TB disease and pneumonia. It can be implemented with minimal need for human intervention. However, while presenting results of this study, Dr Fleming Lure investigator of the study cautioned that, “AI can function as a second pair of eyes. It does not replace the humans but provides references for healthcare professionals to make a final diagnosis. Also, this small study lays good groundwork for the future of AI in the large clinical evaluations and simplify the diagnosis process”.

109 months are left to end TB worldwide: will new tools be pivotal?

The fight to end TB is a human rights imperative. We have to use all existing tools to prevent, diagnose and treat TB rationally and to maximal potential, as well as, fully fund the research and development of new and better tools - and - also ensure that new tools are rolled out and reach the people in-need as soon as possible without any delay.

* Shobha Shukla wrote this article for
The writer is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate.
She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media).
Follow her on Twitter @shobha1shukla or visit
This article was webcasted on November 05 2021.

* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.

  • Imoinu Erat Thouni @ Koubru #2:: Gallery
  • COVID-19 Status 28 Jan : Govt of Manipur
  • COVID-19 : Impact in Manipur :: News Timeline
  • Living green makes sense: Go Green
  • In the stillness of the night :: Poem
  • A career in mining engineering
  • Pre-poll ticket tussle ... tension inevitable
  • The virus : Always one step ahead
  • Gaan-Ngai @Iboyaima Shanglen #3:: Gallery
  • COVID-19 Status 27 Jan : Govt of Manipur
  • COVID-19 Status 26 Jan : Govt of Manipur
  • Manipur Assembly Election (2007-2022) #1
  • World Meetei Council website launched
  • Homecoming of missing Arunachal youth
  • Winter vegetable that will give you glow
  • State hapless in preventing Omicron
  • The wait for the list continues
  • Republic Day @Kangla #1 :: Gallery
  • No matter what :: Poem
  • Fear of the virus
  • The Peace Forest Initiative
  • The vehicle for NEP 2020
  • Contribution of Leimayol Arts Centre
  • COVID-19 Status 25 Jan : Govt of Manipur
  • Lotus plant: A multipurpose plant species
  • Primary School renovated at Joupi
  • Republic Day recollections
  • Huge skills gap making new jobs go abegging
  • National Voters' Day
  • Lining up for BJP ahead of polls
  • Lainingthou Sanamahi Complex #2:: Gallery
  • COVID-19 Status 24 Jan : Govt of Manipur
  • BAMCHAS biennial conference 2022
  • COVID Vaccine Booster: To give or not
  • Before I sleep... III
  • Indian Army as a career option
  • 20-yr MoU to set up Mini-Grid in Nagaland
  • Season of promises!
  • Election curbs; relief for commoners
  • First manifesto, then candidates list
  • Imoinu @Yumnam Leikai :: Gallery
  • COVID-19 Status 23 Jan : Govt of Manipur
  • Our Ailing Planet: My locality as a facet
  • Stop Oil Palm Plantation in Manipur
  • General election in hard times :: Poem
  • Being free from freedom
  • Roaring 40 in first list of Cong
  • Significance of Gaan-Ngai festival #2
  • COVID-19 Status 22 Jan : Govt of Manipur
  • Wake Up My People Wake up :: Poem
  • A tribute to Athokpam Indrakumar Singh
  • Stunted fingerling- Replacement of fish seed
  • Training Program at Dimapur
  • Gaan-Ngai @Kakhulong :: Gallery
  • COVID-19 Status 21 Jan : Govt of Manipur
  • Classical Language Vs ST for Meetei
  • The Great Green Walls, conserving nature
  • Webinar: The Birds and Bees Talk
  • Covid Booster Campaign at Tamenglong
  • IVF Centre in Guwahati
  • Easing curbs as cases spiral
  • Third wave is on!
  • Ecotourism Complexes @ Ramrei :: Gallery
  • COVID-19 Status 20 Jan : Govt of Manipur
  • No excuse not to end acute pandemic stage
  • Palm-oil in Manipur: Bad to worse
  • For sons and daughters :: Poem
  • Effective methods for facial hair removal
  • Subdued dissent over Sunday as poll day
  • Embracing the party hoppers
  • Gaan-Ngai @Iboyaima Shanglen #2:: Gallery
  • COVID-19 Status 19 Jan : Govt of Manipur
  • Cultural Activists of Manipur honoured
  • Male infertility: What are the options ?
  • Is celebrating New Year Day really worth it
  • Third wave: State on record breaking spree
  • Compulsion of power politics
  • Imoinu Thouniba @Singjamei :: Gallery
  • COVID-19 Status 18 Jan : Govt of Manipur
  • O Jonga! O Jonga :: Poem
  • Grey market for election tickets
  • Some common weeds of Manipur #2
  • Lilong Haoreibi College awarded 'B' grade
  • State used as transport route of drugs
  • Possible post poll scenario
  • Significance of Gaan-Ngai festival #1
  • COVID-19 Status 17 Jan : Govt of Manipur
  • Lunghar path in springshed conservation
  • Lament of love :: Poem
  • Career options in Lift Technology
  • Brief tale of one year COVID vaccination
  • Bickering among allies in coalition politics
  • Low vaccination coverage
  • NH-2 : Remember Khongnem Thana
  • COVID-19 Status 16 Jan : Govt of Manipur
  • O Kolhen! O Kolhen :: Poem
  • Program on POCSO Act at Thoubal
  • The Killing Fields (2013-22) :: News Timeline
  • A spate of 'defections' in UP elections...
  • High performing individuals work alone
  • Onus on ECI to avert crisis situation
  • Keeping people informed is key
  • Gaan-Ngai @Iboyaima Shanglen #1:: Gallery
  • COVID-19 Status 15 Jan : Govt of Manipur
  • The church is & must remain apolitical
  • Tamenglong Battalion celebrated Army Day
  • How prosperous NE India became backward
  • Imoinu Erat Thouni @ Koubru #1:: Gallery
  • COVID-19 Status 14 Jan : Govt of Manipur
  • Read all about Gaan Ngai
  • Justice, Peace and Change :: Poem
  • Mass Surya Namaskar at Tamenglong
  • Padmanabha Swamy Temple
  • Overcoming vaccine hesitancy
  • Nothing grand about 'Grand Old Party'
  • Lainingthou Sanamahi Complex #1:: Gallery
  • COVID-19 Status 13 Jan : Govt of Manipur
  • A Hymn for Goddess Emoinu
  • Some common weeds of Manipur #1
  • How to keep your hair healthy this winter
  • Third wave: Litmus test for NE states
  • High TPR, low vaccination
  • Maharaja Gambhir Singh
  • COVID-19 Status 12 Jan : Govt of Manipur
  • Rani Gaidinliu Open Air Lounge inaugurated
  • NAAC peer team visit for assessment
  • National Youth Day
  • Conservation Agriculture: intensified farming
  • Negligence galore as Covid cases rise
  • Back to the spike in three figures
  • How AFSPA undermines 'Act East' Policy
  • COVID-19 Status 11 Jan : Govt of Manipur
  • P Achevei : Mega Mister North East 2021
  • Stop Violence related to Election
  • Civil / Project Engineer @ R-Square
  • Business Development @ R-Square
  • Customer Representative @ Property Geo
  • No matter what :: Poem
  • Stealthy extension of AFSPA
  • Confiscating 'suspected heroin'
  • 188 Death Anniv: Maharaj Gambhir:: Gallery
  • COVID-19 Status 10 Jan : Govt of Manipur
  • Biotechnology Ignition Grant (BIG) 20th Call
  • Kalum Kai (House of worship) #2
  • Account Assistant @ Amber & Arthur, Imphal
  • Business Dev @ Amber & Arthur, Imphal
  • The 5G Race :: Samarjit Kambam
  • Manipur elections not for the faint-hearted
  • Guns & violence in run up to polls
  • Climate Change in Ukhrul in last 50 years
  • COVID-19 Status 09 Jan : Govt of Manipur
  • Are we able to break chain of transmission
  • 100 new Sainik School- opportunities for girl
  • Joyjeet Waikhom / Ksh Maradona: Mr India
  • Money flying in or out ?
  • Will partial lockdown help curb transmission
  • Voting during Covid pandemic
  • Food items @ Singjamei, Pishum :: Gallery
  • COVID-19 Status 08 Jan : Govt of Manipur
  • Curfew : Measures to combat COVID
  • IMFP - Indian Made Foreign People
  • Happy 2022 to you !
  • Manipur Press Foundation Day :: Gallery
  • COVID-19 Status 07 Jan : Govt of Manipur
  • Politician must practice, preach on COVID
  • Makeup routine during pandemic
  • Third wave threat no more a mirage
  • Queuing up for BJP
  • Thangal Lambi & Ima Keithel :: Gallery
  • COVID-19 Status 06 Jan : Govt of Manipur
  • Before I sleep... II
  • Election Brawl :: Poem
  • Impact of Covid on Employer Branding
  • Chasing peace in Manipur
  • COVID-19 Status 05 Jan : Govt of Manipur
  • Kalum Kai (House of worship) #1
  • The art of New Year's resolution
  • Cong struggling to keep its house in order
  • Manipur's place in the eyes of Delhi
  • Makru bridge, Oinamlong Waterfall : Gallery
  • COVID-19 Status 04 Jan : Govt of Manipur
  • Depression : A New Time Bomb
  • School & Student Championship Quiz
  • Concern over child labour
  • ECI on sluggish vaccination rate in state
  • Vaccination rate in hill districts
  • Fusion of contemporary dance & theatre
  • COVID-19 Status 03 Jan : Govt of Manipur
  • COVID-19 Crackdown on violators
  • AMAND, Pune released 2022 calendar
  • Rising poverty in Manipur
  • Sunset, the most memorable!
  • Election time season of plentiful promises
  • Interesting role of NPP, NPF
  • Pineapple @ Ngariyan Hills #2 : Gallery
  • COVID-19 Status 02 Jan : Govt of Manipur
  • kLlQtre :: Seireng
  • National Day for our feathered friend
  • Value of purposeful life
  • Homemade face packs for winter beauty
  • Dreadful start to New Year as cases spike
  • Manipur steps into Year 2022
  • Tarpon Katpa @ Loktak #2 : Gallery
  • COVID-19 Status 01 Jan : Govt of Manipur
  • OneHealth: towards pandemic preparedness?
  • Before I sleep...
  • Meitei ST demand & the opposition
  • Bye Bye 2021 : Gallery
  • COVID-19 Status 31 Dec : Govt of Manipur
  • Featured Front Page Photo 2021 #6: Gallery
  • Manipur : National Futsal C'ship 2021
  • 'Unlocking Locks Under Lockdowns' released
  • Baby corn cultivation for livelihood
  • Extension of AFSPA to Nagaland
  • Hoping for a better New Year 2022
  • Appeal of AMCO to Chief Minister
  • NK Sanajaoba- Star in Dark Sky of Manipur
  • Danube Kangjam : Miss North East 2021
  • Armed Forces Special Powers Act, 1958
  • January Calendar for Year 2022 : Tools
  • Carol on Christmas :: Poem
  • Formation of 13 Farmer Producer Orgns
  • Indian Army Inquiry Team visits site in Oting
  • Review home isolation rule or punish violator
  • Lining up for saffron party
  • Red Ribbon Manipur Idol, 2021 #2: Gallery
  • Job-Fair 2021 @ Imphal : Gallery
  • Christmas Eve @ Imphal : Gallery
  • Christmas Eve @ Churachandpur : Gallery
  • Red Ribbon Manipur Idol, 2021 #1: Gallery
  • Heisnam Savitri (Legendary actress) #2
  • Painting: Tribal Freedom Fighter #1: Gallery
  • New Barak Bridge @Jiri highway : Gallery
  • Heisnam Savitri (Legendary actress) #1
  • RK Meghen tribute @ Nupi Lal : Gallery
  • Protest: massacre of Naga Brethen: Gallery