As many as 1.6 million people died of tuberculosis in 2021 during the COVID-19 pandemic, according to the World Health Organization’s 2022 Global TB report.
File photo of a doctor analyzing an X-ray of a patient being treated for tuberculosis. (Photo: Reuters)
By Milan Sharma: An estimated 10.6 million people became ill with tuberculosis (TB) in 2021, a 4.5% increase from 2020, and 1.6 million people died from tuberculosis (including 1.87,000 among HIV-positive people) , according to the World Health Organization 2022 Global TB report.
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. This is the first time in many years that there has been a reported increase in the number of people getting sick with TB and drug-resistant TB. TB services will be disrupted, among other things, by the COVID-19 pandemic in 2021, but its impact on TB response has been particularly severe. Ongoing conflicts in Eastern Europe, Africa and the Middle East have further exacerbated the situation for vulnerable populations.
“If the pandemic has taught us anything, it is that with solidarity, determination, innovation and the equitable use of resources we can face serious health threats. Let’s apply those lessons to tuberculosis. It’s time to put an end to this ancient killer. Working together, we can end TB,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.
Continued challenges in providing and accessing essential TB services have left many people with TB undiagnosed and untreated. The reported number of newly diagnosed people 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.
Reducing the reported number of people diagnosed with TB suggests that the number of people with undiagnosed and untreated TB has increased, leading first to an increase in TB deaths and community transmission of infections, and then , with some delay, an increase in the number of people developing TB.
The number of people being treated for RR TB and multidrug-resistant TB (MDR TB) also decreased between 2019 and 2020. The reported number of people starting treatment for RR TB in 2021 was 161,746, only about three of the needy.
The report notes a decline in global spending on essential TB services from $6 billion in 2019 to $5.4 billion in 2021, less than half of the global target of $13 billion per year by 2022. the funding used in 2021 (79%) came 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, Tuberculosis and Malaria (Global Fund). The United States government is the largest contributor to the financing of the Global Fund and is also the largest bilateral donor; in total, it contributes nearly 50% of international donor funding for TB.
Amid the stagnant progress, there are some successes. As many as 26.3 million people were treated for TB between 2018 and 2021, still well below the 40 million targets set for 2018-2022 at the UN high-level meeting on TB. Of the 30 countries with a high TB burden, Bangladesh, Brazil, China, Uganda and Zambia were the countries with the highest treatment coverage in 2021. The number of people receiving preventive treatment for TB recovered in 2021 to almost the level of 2019 , but the cumulative total of 12.5 million between 2018 and 2021 was still a long way from the target of 30 million at the end of 2022.
On a more positive note, TB preventive treatment for people living with HIV has far surpassed the global target of 6 million in 2018-2022, reaching more than 10 million in just 4 years. Seven countries – India, Nigeria, South Africa, Uganda, United Republic of Tanzania, Zambia and Zimbabwe – together accounted for 82% of those starting preventive treatment in 2021.
Seven countries with a high TB burden in the region – Ethiopia, Kenya, Lesotho, Namibia, South Africa, United Republic of Tanzania and Zambia – have reached the 2020 milestone of 20% reduction in TB incidence compared to 2015 or surpassed.
Countries are also increasingly using new tools and guidelines recommended by the WHO, resulting in early access to TB prevention and care and better outcomes. The proportion of people diagnosed with tuberculosis initially tested with rapid diagnosis increased from 33% in 2020 to 38% in 2021. At least 109 countries used full-oral longer regimens (up from 92 in 2020) to treat MDR/RR-TB , and 92 used shorter regimens (compared to 65 in 2020).