Tuberculosis has regained the title of the most deadly infectious disease. WHO says it's an “outrageous act”

by Fran CritzNPR

The ancient scourge of tuberculosis was for many years the deadliest infectious disease. Then SARS-CoV-2 emerged and took on the infamous title of #1 killer. In 2020, 3.5 million people died from COVID-19 worldwide, while 1.5 million people died from tuberculosis.Global Tuberculosis Report 2024, Tuberculosis has once again risen to the top of the list, with 1.25 million deaths expected in 2023, compared with 320,000 deaths from COVID-19, according to a report released by the World Health Organization last week. There were also hundreds of thousands of new tuberculosis cases in 2023 compared to the previous year.

The number of deaths due to tuberculosis in 2023 is 1.25 million, down from 1.32 million in 2022 (the number of deaths in the same year is second only to the number of deaths due to the new coronavirus). But public health leaders say it's still indefensibly high.

WHO Director-General Tedros Adhanom Ghebreyesus said: “It is outrageous that despite the tools we have to prevent, detect and treat tuberculosis, so many people are still dying and getting sick.” in a statement Published on October 29th.

According to the report, approximately 8.2 million people were newly diagnosed with tuberculosis in 2023, the highest number since WHO began global tuberculosis monitoring in 1995, and 2022 This is a “significant increase” from the 7.5 million people diagnosed with tuberculosis in 2017.

Tuberculosis experts are trying to understand the reasons behind the increase. Anand Date, director of the Global Tuberculosis Branch at the Centers for Disease Control and Prevention, said the increase in cases last year could be due to population growth, and he is not sure if that is true or if the number of cases is surging. He said it may take until 2024 to know if there are any. 2023 reflects an underestimate of the annual total number of tuberculosis cases during the pandemic.

“With TB programs suspended at the height of the pandemic, more people were left without TB diagnosis or treatment. [And] They say shelter-in-place instructions may also have limited the spread of tuberculosis. Jurgen Pillay He leads efforts to improve the implementation of tuberculosis programs at the Bill and Melinda Gates Foundation (which funds NPR and this blog).

COVID-19 has caused another setback in efforts to control tuberculosis. But most of the reasons why infections persist are frustratingly familiar. Lucica Ditiu Executive Director of the Stop Tuberculosis Partnership. There is too little funding for research and treatment. And we need patient care. And there is a stigma that prevents poor people, including immigrants and sex workers, who are the most common victims of tuberculosis, from seeking help and being provided treatment.

In addition, health conditions such as malnutrition, diabetes and smoking can worsen tuberculosis and make drugs less effective, it said. luke davis Tuberculosis and HIV expert at Yale School of Public Health. “Tuberculosis is special,” Davis says. Most people who are exposed to the bacteria do not progress to infectious tuberculosis. Only about 10% do so, and they are usually among the poorest people in the world and often have poor health to begin with, which worsens their symptoms. ”

So what's the solution?

And that brings us to Tedros' point. The world knows how to beat tuberculosis, but we are not doing enough.

Perhaps the biggest obstacle to defeating tuberculosis is money. A WHO spokesperson told NPR: “Compared to the global funding targets for tuberculosis set by the 2023 United Nations High-Level Conference on Tuberculosis, there is a significant funding shortfall not only for tuberculosis research but also for prevention, detection and treatment services. Closing the gap requires more funding, both from domestic sources in countries most affected by TB and from international aid agencies.”

According to the WHO, global funding for tuberculosis prevention and treatment will fall to $5.7 billion in 2023 from $6 billion in the previous three years, still far below the annual target of $22 billion.

What could you get for more money? WHO points out the importance of expanding rapid diagnostic tests. This will allow you to start treatment sooner. People also don't have to travel long distances to clinics and wait days for results.

The increased funding would also help families compensate for lost wages, food and travel costs when going to treatment. These costs make treatment unavailable to some patients and their families.

The WHO report and other studies say countries suffering from tuberculosis also need to spend more on prevention, diagnosis and treatment. report For example, an MSF/Médecins Sans Frontières report published last month echoed the WHO's recommendation to start tuberculosis treatment in children when symptoms are highly suggestive of tuberculosis, even with bacteriological testing. It was found that only 5 out of 14 countries have applied the guidelines based on the is negative.

And the increased funding will speed up the pace of research, the CDC dates. According to the WHO, funding for tuberculosis research has stalled at about $1 billion a year, limiting progress. UN Conference Goal: $5 billion per year by 2027. “The world also has the most promising research and development pipeline of new TB tools in decades,” Pillay said. “What we need now is greater investment to deliver on the promise of that pipeline and ensure that patients and people at risk of TB have affordable and equitable access to these tools when they become available. .”

Vaccine under development

Pillay said there are more than a dozen tuberculosis vaccine candidates in clinical trials, including one whose late-stage (Stage 3) clinical trials are sponsored by the Gates Medical Institute. The trial began recruiting patients in March last year. The vaccine candidate is called M72/AS01E, and if proven effective, it would be the first new tuberculosis vaccine in 100 years. The only tuberculosis vaccine currently available does not work as expected in adults and can cause false-positive results in tuberculosis skin tests.

But even an effective vaccine won't help much if countries affected by tuberculosis don't have the funds to buy it. Janine Madan Keller Vaccine Alliance Gavi is paying for it, said the deputy director of the Global Health Policy Program at the Washington, D.C.-based Center for Global Development. [a variety of] Vaccinations have been rolled out in some of the poorest countries, such as Afghanistan, Burundi and the Democratic Republic of the Congo, but some countries with high rates of tuberculosis are middle-income countries such as Indonesia, and are no longer eligible for aid. . Before a tuberculosis vaccine is approved, policies and funding need to be better aligned, Keller said.

“It seems that in many cases, when we find a way to overcome tuberculosis, we also find other barriers,” says Lucica Ditiu.

Fran Critz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. she also washington post and Very Well Health. Find her on X: @fkritz