War in Ukraine could disrupt critical TB services, experts warn
In 2014, the United Nations initiated the End TB Strategy, setting a goal of ending tuberculosis by 2035.
Over the following years, data showed that the world made progress against TB, achieving reductions in new cases and deaths. However, gains have been reversed during the COVID-19 pandemic.
Now, experts warn that Russia’s invasion and the war in Ukraine could disrupt services in a region with a high burden of TB.
“The unbelievably, almost indescribable situation in Ukraine with the invasion and the war — that has really just put total havoc on the ability to treat a disease like TB,” Mel Spigelman, MD, president and CEO of the TB Alliance, told Healio.
Spigelman explained that Ukraine “has had a particular problem with TB, going all the way back to the Soviet era, when the whole Soviet Union really was a hotbed of drug-resistant TB.”
“That still exists in most of the countries that comprise the former Soviet Union, so we already had an underlying situation in Ukraine where drug-resistant TB was a significant problem, probably made worse by COVID and now it’s been made unbelievably worse by the fact that hospitals aren't available,” he said.
Exasperating the situation further, according to Spigelman, is the fact that many patients with TB in Ukraine are likely on the move.
“For somebody who either is sick and needs to be diagnosed, or somebody who is under active treatment, TB becomes really intolerable,” Spigelman said. “They're sick and they clearly are not the kind of people who are going to engage in fighting the war, so they are trying to seek refuge in other countries. They're traveling, they're crossing borders, they are probably missing a lot of their treatment. It really opens everybody up to the spread of TB and to the worsening of TB, even in those patients that are already unfortunately sick. It's pretty horrible.”
Globally, Spigelman said there are about 2 billion people infected with TB, with about 10 million having active TB and 1.4 million dying annually despite the disease being treatable. Before COVID-19, these statistics made TB the largest infectious disease killer in the world.
Disruptions caused by COVID-19 led to a drastic decline in the diagnosis and treatment of TB in 2020, ranging from 16% to 41% in nine of the countries with the most TB cases, bringing the overall number of people diagnosed and treated for TB in those countries to 2008 levels.
Data published Thursday in MMWR to coincide with World TB Day showed that reported TB diagnoses in the United States fell 20% in 2020 and remained 13% lower in 2021 than diagnoses made before the COVID-19 pandemic. The CDC said these data suggest that the pandemic has had a substantial effect on TB trends in the U.S.
“Before COVID-19, TB disease diagnoses typically declined between 1% and 2% each year. The 2020 and 2021 declines may be related to factors associated with the COVID-19 pandemic, including a true reduction in incidence, as well as delayed or missed TB diagnoses,” the CDC said in a statement accompanying the new study.
Spigelman said that because COVID-19 “drains so many resources” from health care systems — especially in poorer countries — it has worsened the situation for the first time in a long time.
“TB is an age-old pandemic. We've been afflicted for thousands of years,” Spigelman said. “Those of us fortunate enough to be in high-income countries have sort of taken TB for granted as not being a problem, but just like with COVID and any other airborne transmissible disease, TB anywhere is potentially TB everywhere, especially with migration. So, we really need to get on top of this and get TB under control.”