Tuberculosis deaths rise for first time in more than a decade due to COVID-19 pandemic

The COVID-19 pandemic has reversed years of global progress in the fight against tuberculosis, and for the first time in more than a decade, tuberculosis mortality has risen, according to World Health Organization Global TB Report 2021.

In 2020, more people died from tuberculosis, with far fewer people being diagnosed and treated or receiving preventive TB treatment compared to 2019, and total spending on essential TB services falling.

The first challenge is to cut off access to TB services and reduce resources. In many countries, human, financial, and other resources have been diverted from the fight against tuberculosis in response to COVID-19, limiting the availability of basic services.

The second is that people struggled to seek care in the context of incarceration.

“This report confirms our fears that disruption of basic health services due to the pandemic could begin to destroy years of progress in the fight against tuberculosis,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “This is alarming news that must serve as a global alarm for the urgent need for investment and innovation to close gaps in diagnosis, treatment and care for the millions of people affected by this ancient disease that can be prevented and treated.”

Tuberculosis services were disrupted by the COVID-19 pandemic in 2020, among others, but the impact on tuberculosis was particularly severe.

For example, approximately 1.5 million people died of tuberculosis in 2020 (including 214,000 among HIV-positive people).

The increase in the number of deaths from tuberculosis has occurred mainly in the 30 countries with the highest burden of tuberculosis^[1]. WHO modeling projections suggest that the number of people who develop tuberculosis and die from the disease could be much higher in 2021 and 2022.

Challenges in providing and accessing basic TB services meant that many people with TB were not diagnosed in 2020. The number of new TB cases and those reported to national governments fell from 7.1 million in 2019 to 5.8 million in 2020. .

The WHO estimates that about 4.1 million people currently suffer from tuberculosis but have not been diagnosed with the disease or have not officially reported it to national authorities. This figure is higher than 2.9 million in 2019.

The countries that contributed most to the global decline in tuberculosis awareness between 2019 and 2020 were India (41%), Indonesia (14%), the Philippines (12%) and China (8%). These and 12 other countries accounted for 93% of the total global decline in information.

The provision of preventive TB treatment has also been reduced. About 2.8 million people acceded to this in 2020, a decrease of 21% compared to 2019. In addition, the number of people treated for drug-resistant tuberculosis fell by 15%, from 177,000 in 2019 to 150,000 in 2020, which is the equivalent of only about 1 in 3 of those who need it.

Global investment in tuberculosis is declining

Funding in low- and middle-income countries (LMICs), which account for 98% of reported TB cases, remains a challenge. Of the total funding available in 2020, 81% comes from domestic sources, and the BRICS countries (Brazil, the Russian Federation, India, China and South Africa) account for 65% of total domestic funding.

The largest bilateral donor is the United States Government. The largest international donor is the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The report notes a drop in global spending on TB diagnosis, treatment and prevention services from $ 5.8 billion to $ 5.3 billion, less than half of the global goal of fully funding TB response of $ 13 billion a year by 2022. .

Meanwhile, although there is progress in developing new TB diagnostics, drugs and vaccines, it is limited by the total level of investment in research and development, which is $ 0.9 billion in 2019, far from the global target of $ 2 billion per year.

The global goals of tuberculosis are off track

The upheavals in progress mean that the global goals of tuberculosis are off track and seem to be all unattainable, however there are some successes. Globally, the decline in number of deaths from tuberculosis between 2015 and 2020 it was only 9.2% – roughly a quarter of the way to the 2020 milestone of 35%.

Globally, number of tuberculosis patients each year (in relation to the number of inhabitants) fell by 11% from 2015 to 2020, just over halfway to the 2020 milestone of 20%.

However, the WHO European Region exceeded the 2020 milestone, with a 25% reduction. This was mainly due to the decline in the Russian Federation, where the incidence fell by 6% per year between 2010 and 2020. The WHO African region is close to reaching a milestone, with a decrease of 19%, reflecting an impressive decrease of 4-10% per year in South Africa and several other countries in South Africa, following the peak of the HIV epidemic and the spread of TB prevention and care.

“We have only one more year left to achieve the historic 2022 tuberculosis targets committed by the heads of state at the first UN high-level meeting on tuberculosis. The report provides important information and a strong reminder to countries to urgently accelerate their responses to tuberculosis and save lives, ”said Dr. Tereza Kasaeva, director of the World Health Program to Fight Tuberculosis. “This will be crucial as preparations begin for the second UN high-level meeting on TB scheduled for 2023.”

The report calls on countries to take urgent measures to restore access to basic TB services. It further calls for a doubling of investment in tuberculosis research and innovation, as well as for concerted action across the health sector and others to address the social, environmental and economic determinants of tuberculosis and its consequences.

The new report contains data on disease trends and the response to the epidemic from 197 countries and territories, including 182 from 194 member states of the World Health Organization (WHO).

Note to the editor

Since declaring COVID-19 an emergency in public health of international importance, WHOThe Global Tuberculosis Program monitored the impact of the pandemic on tuberculosis services and provided guidance and support.

Global goals

In 2014 and 2015, all WHO and UN member states adopted the UN Sustainable Development Goals (SDGs) and the WHO Strategy for Ending Tuberculosis. The Sustainable Development Goals and the Tuberculosis Eradication Strategy include goals and milestones to greatly reduce the incidence of TB, TB mortality, and the costs faced by TB patients and their households.

The WHO strategy on cessation of tuberculosis aims to reduce tuberculosis mortality by 90 percent and reduce the incidence rate of tuberculosis to 80 percent by 2030, compared to the 2015 baseline. The milestones for 2020 include a 20% reduction in the TB rate and a 35% reduction in TB mortality.

The UN Political Declaration on TB also included 4 new targets for the period 2018-2022:

• You are treating 40 million people for tuberculosis
• Reach at least 30 million people with preventative TB treatment for latent TB infection
• Mobilize at least $ 13 billion annually for universal access to tuberculosis diagnosis, treatment, and care
• Mobilize at least $ 2 billion annually for tuberculosis research

TB facts

Tuberculosis (TB), the second (after COVID-19) most deadly killer of the infection, is caused by bacteria (Mycobacterium tuberculosis) that most commonly affect the lungs. It can spread when people with TB release bacteria into the air – for example, by coughing.

Approximately 90 percent of TB patients live in 30 countries each year. The majority of people who develop the disease are adults – in 2020 – men accounted for 56% of all TB cases, adult women accounted for 33% and children 11%. Many new cases of tuberculosis are attributed to five risk factors: malnutrition, HIV infection, alcohol use disorders, smoking, and diabetes.

TB can be prevented and cured. About 85% of people who develop TB disease can be successfully treated with a six-month medication regimen; Treatment has the added benefit of reducing further transmission of the infection.

^[1] The 30 countries with the highest TB burden are: Angola, Bangladesh, Brazil, Central African Republic, China, Congo, Democratic People’s Republic of Korea, Democratic Republic of the Congo, Ethiopia, Gabon, India, Indonesia, Kenya, Lesotho, Liberia, Mongolia, Mozambique, Myanmar, Namibia, Nigeria, Pakistan, Papua New Guinea, the Philippines, Sierra Leone, South Africa, Thailand, Uganda, the United Republic of Tanzania, Vietnam and Zambia.