‘A global wake-up call’: In shadow of COVID-19, TB deaths rise for first time in 15 years
Disruptions caused by the COVID-19 pandemic have reversed years of global progress in the fight against tuberculosis, leading to an increase in deaths from TB for the first time in over a decade, according to WHO’s 2021 Global TB report.
Deaths from TB returned to 2017 levels, with more than 1.5 million people dying of the disease last year — an increase from the more than 1.4 million who died from TB in 2019. It was the first time since 2005 that there was a year-on-year increase in TB deaths, according to the report.
“This report confirms our fears that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said in a press release. “This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.”
Increases in deaths, decreases in care
According to the report, TB services are among many that have been disrupted by the COVID-19 pandemic. However, WHO said the impact on TB has been “particularly severe.”
Overall, among the more than 1.5 million people who died from TB in 2020, 214,000 deaths occurred among HIV-positive patients, also an increase over 2019. The report explained that the increase in TB deaths occurred mainly in the 30 countries reported to have the highest burden of TB. Projections show that death counts may be “much higher” in 2021 and 2022.
Despite the increase in deaths, WHO found that the number of newly reported cases of TB fell from 7.1 million in 2019 to 5.8 million in 2020. According to WHO, estimates suggest that around 4.1 million people are infected with TB but have not been diagnosed, which is nearly 1.2 million more than estimated in 2019.
The WHO report also outlined a reduction in preventive TB treatment. According to the report, 2.8 million people accessed preventive treatment in 2020, which was a 21% reduction from 2019. Similar reductions were seen among people treated for drug-resistant TB. According to WHO, there was a 15% decrease, lowering the case count from 177,000 in 2019 to 150,000 in 2020, which experts said is “equivalent to only about one in three of those in need.”
Goals ‘increasingly out of reach’
According to the WHO report, funding for TB in low- and middle-income countries which account for 98% of reported TB cases remains a challenge. In 2020, 81% of funding for the fight against TB came from domestic sources, with Brazil, China, India, Russia and South Africa accounting for 65% of total domestic funding, whereas the U.S. remained the largest bilateral donor.
Despite these donors remaining active, the WHO report showed an overall decrease in global spending on TB diagnostics, treatment and prevention services from $5.8 billion to $5.3 billion. WHO said this is less than half of the global target for fully funding the TB response of $13 billion annually by 2022. The report also said that funding goals for the development of new diagnostics, drugs and vaccines also falls short of the global target of $2 billion per year by remaining under $1 billion.
Financial goals are not the only targets being missed in the fight against TB, according to the WHO report. In 2014 and 2015, WHO and the United Nations estalished the United Nations Sustainable Development Goals and WHO’s End TB Strategy, which both include targets for reductions in TB incidence, deaths and costs. These goals include a 90% reduction in TB deaths and an 80% reduction in the TB incidence rate by 2030 compared with the 2015 baseline. Milestones for 2020 include a 20% reduction in incidence and a 35% reduction in deaths.
Unfortunately, disruptions in reporting and treatment have sent these targets off track, according to the WHO report, making them appear “increasingly out of reach.”
“We have just 1 year left to reach the historic 2022 TB targets committed by heads of state at the first U.N. High Level Meeting on TB,” Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Programme, said in the press release, adding that the report acts as a strong reminder to countries to urgently fast-track their TB responses. “This will be crucial as preparations begin for the second U.N. High Level Meeting on TB mandated for 2023.”
The WHO report also outlined some successes. Globally, the reduction in the number of TB deaths between 2015 and 2020 was 9.2%, which is roughly a quarter of the way to the 2020 milestone of 35%. Additionally, the number of people infected with TB globally each year declined 11% from 2015 to 2020, which is just more than half-way to the 2020 milestone of 20%.
Considering these findings, the report called on countries to put urgent measures in place to restore access to TB services and for a doubling of investments in TB research and innovation.
“Emerging from the COVID-19 pandemic only to have lost even more people to TB is simply unacceptable. The member states of the United Nations — the entire world — [have] made pledge after pledge to tackle TB,” Mel Spigelman, MD, president and chief executive officer of the TB Alliance, said in a statement. “It’s time to honor those commitments and reinvigorate the effort to end the world’s oldest pandemic.”
WHO. Global tuberculosis report 2021. https://www.who.int/publications/i/item/9789240037021. Accessed Oct. 14, 2021.