Dismal global tuberculosis situation due to COVID-19
Authors: Sanjeet Bagcchi
Journal: The Lancet Infectious Diseases (2021)

The WHO global tuberculosis report 2021 was released in October, and for the first time in 10 years described a global increase in deaths from tuberculosis. Sanjeet Bagcchi reports. The WHO global tuberculosis report 2021, which looked at data from 197 countries and areas, has unveiled that disruptions caused by the COVID-19 pandemic have led to a reversal in the progress made in combating tuberculosis globally. Also, for the first time in more than 10 years, there has been a global increase in deaths from tuberculosis. According to the report, an estimated 1·3 million deaths among HIV-negative people and 214 000 deaths among HIV-positive people occurred worldwide in 2020, compared with 1·2 million and 209 000 deaths among HIV-negative and HIV-positive people, respectively, in 2019. The increase in deaths due to tuberculosis was mostly reported from 30 countries with the highest burden of the disease, including Angola, Congo, Bangladesh, China, and Brazil. The pandemic has led to a substantial decrease (by 1·3 million) in the number of individuals newly diagnosed with tuberculosis and reported to governments—from 7·1 million in 2019 to 5·8 million in 2020, said the report. Countries contributing most to the global decrease in tuberculosis notifications during 2019–20 included India (41%), Indonesia (14%), the Philippines (12%), and China (8%). “It is very disturbing, albeit not surprising, to see the weakening of global TB control efforts associated with the COVID pandemic”, said Sarah Fortune (Harvard TH Chan School of Public Health, Boston, MA, USA). “It is likely that these numbers reflect both programmatic strains and potentially some biologic interactions between SARS-CoV-2 infection and TB infection”, she added. “This increase in TB deaths is a tremendous setback for the world and our fight against one of the oldest infectious diseases”, said Muhammad Osman (Desmond Tutu TB Centre, Cape Town, South Africa). “Strategies to find and diagnose people with TB were interrupted with lockdowns and limitations on movement”, he added. Explaining the challenges associated with the COVID-19 pandemic with respect to the global tuberculosis situation, WHO said in a statement that the first challenge includes disturbances in accessing tuberculosis-related services and decreases in resources; there were reallocations (from addressing tuberculosis to COVID-19) of resources (eg, financial, human) in several countries. The second challenge includes the struggle of people to seek tuberculosis-related health care during lockdowns. Also, in terms of tuberculosis preventive treatment—an intervention mainly provided to people with HIV that helps to cut the risk of Mycobacterium tuberculosis infection progressing to active disease—the report unveiled that there was a 21% decrease in the number of people receiving this treatment globally during 2019–20 (from 3·6 million to 2·8 million), showing a reversal of a positive trend, which was noted during 2015–19 (increasing from 1 million to 3·6 million in that period). “We are heavily worried about how the COVID-19 pandemic has disrupted TB care and prevention in countries with a high TB burden”, said Lucica Ditiu (Stop TB Partnership, Geneva, Switzerland). According to Madhukar Pai (McGill International TB Centre, Montreal, Canada), “the COVID-19 pandemic is a massive setback to our plans to end TB”. He is “convinced that ending the COVID-19 pandemic quickly is essential for rebuilding tuberculosis and all other essential health services”. The report also noted that spending on diagnostic, treatment, and prevention services for tuberculosis significantly decreased globally during 2019–20 (from US$5·8 billion to $5·3 billion). “This is less than half (41%) of the global target of US$13 billion annually by 2022”, the report said. According to WHO, “reversals in progress” with respect to tuberculosis suggest that the global targets for the disease were “off track” and they appeared “increasingly out of reach”. Mel Spigelman (TB Alliance, NY, USA) commented: “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. It’s time to honor those commitments and reinvigorate the effort to end the world’s oldest pandemic”. Experts have suggested measures to improve the global tubercu­losis situation. Richard Chaisson (Johns Hopkins Center for Tuberculosis Research, Baltimore, MD, USA) told The Lancet Infectious Diseases: “what the WHO report shows us is that we have to regain the lost ground and find and treat the patients who weren’t detected in 2020, and commit substantially more resources into controlling the tuberculosis pandemic if we ever hope to achieve the End TB goals”. According to Ditiu, “to get back on track and end TB, country TB responses need to recover from this [COVID-19 pandemic-related] setback, undertake massive scale-up of screening and testing for TB using modern diagnostic tools, and incorporate learnings from the COVID-19 pandemic in their models for TB care and prevention. For all this to happen, high-level political commitment and substantially in­creased financing are essential”.