COVID-19 Pandemic Reverses Global Tuberculosis Progression

The challenge of providing and accessing essential TB services means that many people with TB were not diagnosed in 2020. The number of people newly diagnosed with tuberculosis and reported to the government has dropped from 7 million in 2019 to 5 million in 2020. In addition, WHO estimates that approximately 4 million people currently suffer from tuberculosis, but have not been diagnosed with or officially reported to national authorities. This number is up from 2.9 million in 2019.

The countries that contributed most to the global reduction of TB notifications between 2019 and 2020 were India (41%), Indonesia (14%), the Philippines (12%), and China (8%). These and 12 other countries account for 93% of the total global decline in notifications. The increase in TB deaths occurred mainly in the 30 countries with the highest TB burden.

Due to the delayed effects of COVID-19, tuberculosis deaths are projected to increase again in 2022, but the world will be readjusted to new normalities and service will resume. The report is based on a country model developed for 16 countries, which account for almost all of the global decline in TB notifications from 2019 to 2020 and account for 71% of the estimated TB cases worldwide in 2020. I am making a forecast of the lever. Dr. Teresa Casaeva, director of the WHO Global Tuberculosis Program, said in an email: Lancet Respiratory Medicine.. She explains: “The impact on incidence is delayed compared to the levels expected in the absence of COVID-19, with an over-occurrence of approximately 5-10% around 2022. Modeling is based on the COVID-19 pandemic. We have not yet considered the negative effects on a wider range of tuberculosis determinants, such as income levels and undernourishment, which increase the likelihood of developing tuberculosis in people who are already infected. Many have not considered the effectiveness of mitigation strategies, It depends on the speed at which access to critical TB services is restored, and the scope and effectiveness of the global COVID-19 vaccination program. “

The COVID-19 pandemic affected both sets of TB targets worldwide. First, WHO’s own goals set out in the tuberculosis eradication strategy adopted in 2015. Globally, the reduction in TB deaths from 2015 to 2020 was only 9.2%, about a quarter of what it was by 2020. 35% milestone. Also, the number of people suffering from tuberculosis worldwide each year (compared to the population) declined by 11% between 2015 and 2020, more than just half of the 2020 milestone of 20%. increase. However, there have been some regional successes. The WHO Europe region exceeded the 2020 milestone and fell by 25%. This is mainly due to the decline in Russia, where the incidence decreased by 6% each year between 2010 and 2020. The WHO Africa region is approaching a milestone with a 19% decline, reflecting a remarkable decline of 4-10%. Every year in South Africa and several other countries in southern Africa after the HIV epidemic peaks and the prevention and care of tuberculosis and HIV expands.

Second, the goals set at the United Nations High-Level Conference on Tuberculosis for the first time in 2018 were also significantly affected by COVID-19, but two goals (overall treated for tuberculosis in both adults and children). Number) was still achieved in reality. For adults, the goal for 2022 is to treat 40 million adults, with 19 million (50%) being treated by 2020. For children, the target for 2022 is 3.5 million, and by 2020 approximately 1.4 million children (41%) were treated. Treatment of multidrug-resistant (MDR) and rifampicin-resistant tuberculosis is far behind UN goals, with only 32% of 1 million adults being treated and 11% of 115,000 children being treated. ..

Despite these setbacks, Casaeva decided that the target should not be further derailed or modified, and no matter how difficult it may seem, the rapid progress in working on COVID-19 from a standing start , Shows what is possible to tackle tuberculosis. Similar energy is applied. “If tuberculosis services, which are essential as an urgent issue, are restored, the effects of the COVID pandemic can be reversed. More national and international resources need to be urgently mobilized to combat tuberculosis. There is a need to improve the development and uptake of new technologies and innovative integrated care approaches, especially to levels already achieved in low-burden countries where tuberculosis is often regarded as a past illness. A new tuberculosis vaccine is needed to reduce the incidence rapidly, “she says.

He adds: “What is clear is that large investments in vaccine development can accelerate progress. That is probably the biggest lesson from the COVID-19 vaccine. Governments and pharmaceutical companies are developing the COVID-19 vaccine. Had we spent a small portion of the energy and money we spent on delivering it to a wealthy country, we would have stopped tuberculosis long ago. “

Marks still believes that countries can take swift action to avoid the worst impact of COVID-19 on their mission to manage and ultimately end tuberculosis as a public health issue. I am. “Active detection and treatment of 90% of all cases is the key to ending tuberculosis. Burdening countries have donors to consider how to do this. We need to work with development banks and domestic sources of funding. We need to adopt a gradual approach that starts in one or two states or cities and then expands. “

“I think it’s unrealistic to say that things will improve in 2022. It will take at least five years to get back on track,” said Alimuddin Zumla, a professor of infectious diseases and international health at the University College London, UK. I am. “The damage done to medical services in developing countries is enormous. The COVID-19 pandemic has reversed 20 years of progress in the fight against tuberculosis. The COVID-19 pandemic has been a long-standing pandemic for tuberculosis and HIV. It added an additional burden to the already overkill medical system that was struggling to cope with the double pandemic. ”Zumla said,“ The goal of ending tuberculosis by 2035 is definitely not met. I believe. Therefore, WHO’s goals are completely unrealistic and unachievable. It will take at least a decade to get the global TB control efforts back on track. This also depends on resource allocation and refocusing of global health authorities’ attention. “

Casaeva expressed her positive opinion, saying: The future direction of tuberculosis research is the prevention of infection with new pre-exposure vaccines, including those developed with the latest mRNA technology. Development of new diagnostics and biomarkers. Shorter treatments and other new tools and innovations across the entire range of tuberculosis infections and illnesses. “