Fighting a war with no end

The global tuberculosis epidemic needs to be addressed

The tuberculosis (TB) numbers increased last year for the first time in more than two decades, fueled by the Covid-19 pandemic, which disrupted access to diagnosis and treatment, says the latest global TB report 2022 published by the World Health Organization (WHO). The report indicates that TB has rebounded after years of decline, killing (TB is the world's second deadliest infectious killer after Covid-19 ) an estimated 1.6 million people (mostly impacting Asia) in 2021, which is up 14% in two years. For the first time in years, the number of people infected with drug-resistant strains has also risen globally. 


There are eight countries, (six Asian countries out of eight) that accounted for more than two-thirds of the global total TB cases: India (28%), Indonesia (9.2%), China (7.4%), the Philippines (7.0%), Pakistan (5.8%), Nigeria (4.4%), Bangladesh (3.6%), and the Democratic Republic of the Congo (2.9%). Geographically, in 2021, most people who developed TB were in the regions of South-East Asia (45%), Africa (23%), and the Western Pacific (18%), with smaller proportions in the eastern Mediterranean (8.1%), the Americas (2.9%) and Europe (2.2%). This data shows that TB has turned to be a public health crisis/emergency in the Asian region and needs the urgent attention of policy-makers to take decisive steps in ending this deadly menace. 


Analyzing the reported TB data, it is also found that in 2021 82% of the global TB deaths among HiV-negative people occurred in the African and South-East Asia regions; India alone accounted for 36% of such deaths. The report also says that only one in three people with drug-resistant TB (DR-TB) is getting treatment for the disease and the treatment success rate for DR-TB is now only at 60% globally. These terrible TB statistics, with the rate of TB increased to 2017 levels due to the impacts of Covid-19, is a dangerous and appalling setback for everyone working on TB programs.


The rise of Covid cost more than a decade worth of progress in fighting TB. Another worrying fact coming in this report is that there are lower TB detection rates compared to the year 2019. This means more undiagnosed cases, which will lead to further increase of deaths and transmission. 


Globally, 26.3 million people were treated for TB between 2018 and 2021, though still far short of the 40 million target set four years ago. The report underscores the need for countries to implement urgent measures to restore access to essential TB services. It also calls for increased investments and action to address the broader determinants that influence TB epidemics and their socio-economic impact, as well as the need for new diagnostics, drugs, and vaccines.


Already well below the 2022 goal of $13billion, global annual spending on essential TB services fell from $6b in 2019 to $5.4bn in 2021. And most of the funding for these services (79%) comes from domestic sources. On several occasions, global leaders have pledged commitment to ending the TB epidemic by 2030. But to achieve this goal, everyone -- mainly health ministries from Asia -- must take action, and commit real financial and political will to track, treat, and stop TB from spreading.


The ability to control TB transmission is limited because the current vaccine, known as Bacille Calmette-Guerin (BCG), is more than 100 years old and has also limited efficacy in adults. Medical breakthroughs like effective vaccines, more powerful drug regimens, and point of care TB diagnostics are desperately needed, now more than ever, to end this menace.


TB is underfunded and treatments are extremely long, all the more reason why it is unacceptable in this age of advanced medical science. This is a curable disease and we shouldn't have anyone dying of TB in this day and age. It is now high time to work on developing a new, effective vaccine for tuberculosis as present advancement made in diagnosis and treatment is not enough to end TB. We can do better, we must do better.


Looking at the disease burden, the TB crisis is not going away any time soon in Asia and the WHO must change its advocacy strategy accordingly. The ministers of health in TB-ridden countries, particularly in Asia, may not be the right officials to approach. Instead, efforts must be made to reach out to finance ministers and heads of state in most Asian countries. The 2022 report comes as a severe warning for Asia to tackle this TB epidemic. Asia has to show a strong political commitment to end this disease and allocate more funding towards efforts to stem the deaths of thousands of poor, undiagnosed, and untreated victims.


Sachi Satapathy has worked extensively on Tuberculosis programs in Asian in his previous assignment and currently works as Director, AF Development Care, New Delhi, India. He can be reached at [email protected]