By Sharon Atieno

More effort needs to be put in place to end tuberculosis (TB) after a new World Health Organization (WHO) report shows an increase in TB deaths and incidences.

According to the 2022 Global TB report, the number of people falling ill with TB has reached an estimated 10.6 million in 2021-an increase of 4.5% compared to 2020. Additionally, TB deaths have risen to 1.6 million people.

The burden of drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450,000 new cases of rifampicin-resistant TB (RR-TB) in 2021.

According to the report, COVID-19 played a significant role in disrupting TB services thus, leading to this state. The ongoing conflicts across Eastern Europe, Africa, and the Middle East have further worsened the situation, especially for vulnerable populations.

“If the pandemic has taught us anything, it’s that with solidarity, determination, innovation, and the equitable use of tools, we can overcome severe health threats. Let’s apply those lessons to tuberculosis. It is time to put a stop to this long-time killer. Working together, we can end TB,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General in a statement.

Continued challenges with providing and accessing essential TB services have meant that many people with TB were not diagnosed and treated, the report says, noting that the number of people newly diagnosed with TB fell from 7.1 million in 2019 to 5.8 million in 2020. There was a partial recovery to 6.4 million in 2021, but this was still well below pre-pandemic levels.

Further, the report adds that only one in three of those in need of treatment for RR-TB, around 161 746 were started on treatment in 2021.

“It has become very clear that we now have a very dangerous situation on our hands with an airborne disease that is completely neglected, and which has been allowed to run rampant over the past two years. Transmission has gone up and infections have been left undiagnosed and untreated for longer periods, allowing tuberculosis to fester and develop into advanced forms of the disease, and ultimately leading to higher death rates,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership.

“Despite this shockingly upward trend of TB mortality and infection rates, funding for fighting TB decreased in 2020 and 2021 from an already pathetically low level. This is infuriating and it makes me wonder why there is such a lack of investment in TB. Is it because governments do not care for their own people? Is it because the life of a person dying from TB is less important or is it because TB affects mainly poor people from poorer countries, and it is more comfortable to simply neglect them?”

The report notes a decline in global spending on essential TB services from US$6 billion in 2019 to US$5.4 billion in 2021, which is less than half of the global target of US$13 billion annually by 2022.

As in the previous 10 years, most of the funding used in 2021 (79%) was from domestic sources. In other low- and middle-income countries, international donor funding remains crucial. The main source is the Global Fund to Fight AIDS, TB and Malaria (the Global Fund), which is largely funded by the United States Government and contributes close to 50% of international donor funding for TB.

“The report provides important new evidence and makes a strong case on the need to join forces and urgently redouble efforts to get the TB response back on track to reach TB targets and save lives,” said Dr. Tereza Kasaeva, Director of WHO’s Global TB Programme. “This will be an essential tool for countries, partners, and civil society as they review progress and prepare for the 2nd UN High-Level Meeting on TB mandated for 2023.”

On a positive note, the report finds that 26.3 million people were treated for TB between 2018 and 2021, though short of the 40 million targets set for 2018–2022 at the UN High-Level Meeting on TB.

Further, of the 30 high TB-burden countries, those with the highest levels of treatment coverage in 2021 included Bangladesh, Brazil, China, Uganda, and Zambia. The number of people provided with TB preventive treatment rebounded in 2021 to close to 2019 levels, but the cumulative total of 12.5 million between 2018 and 2021 was still far from the target of 30 million by the end of 2022.

Notably, TB preventive treatment for people living with HIV has far surpassed the global target of six million in the period 2018-2022, reaching more than 10 million in only four years, the report says, highlighting that seven countries – India, Nigeria, South Africa, Uganda, Tanzania, Zambia and Zimbabwe – collectively accounted for 82% of those started on preventive treatment in 2021.

Additionally, seven high TB burden countries in the region – Ethiopia, Kenya, Lesotho, Namibia, South Africa, Tanzania and Zambia- have reached or surpassed the 2020 milestone of a 20% reduction in the TB incidence rate compared with 2015.

Countries are also increasing the uptake of new tools and guidance recommended by WHO, resulting in early access to TB prevention and care and better outcomes. The proportion of people diagnosed with TB who were initially tested with a rapid diagnostic increased from 33% in 2020 to 38% in 2021. 109 countries were reported to be using all-oral longer regimens (up from 92 in 2020) for the treatment of MDR/RR-TB, and 92 were using shorter regimens (up from 65 in 2020).

The report also notes that there has been increased access to shorter (one–three months) rifamycin-based regimens for TB preventive treatment, with185, 350 people in 52 countries being reported to have been treated with rifapentine-containing regimens in 2021, up from 25, 657 in 37 countries in 2020.