Each year, we commemorate World Tuberculosis (TB) Day on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic.
The date marks the day in 1882 when Dr. Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.
TB remains one of the world’s deadliest infectious killers. Each day, over 4,100 people lose their lives to TB and close to 28,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 66 million lives since the year 2000. However, the COVID-19 pandemic has reversed years of progress made in the fight to end TB. For the first time in over a decade, TB deaths increased in 2020.
COVID-19 pandemic
The theme of World TB Day 2022 - ‘Invest to End TB. Save Lives.’ –conveys the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders. This is especially critical in the context of the COVID-19 pandemic that has put End TB progress at risk, and to ensure equitable access to prevention and care in line with WHO’s drive towards achieving Universal Health Coverage. 
More investment will save millions more lives, accelerating the end of the TB epidemic. For the past two years the world's attention has rightly been focused on COVID-19, the most lethal pandemic seen for over a century that has amplified the enormous global toll of respiratory tract infections. COVID-19 remains the top cause of death from an infectious disease worldwide, shifting tuberculosis to second place. In areas highly endemic with tuberculosis, scarce resources have been moved to the COVID-19 response, which has undermined tuberculosis testing and treatment programmes. The effects of COVID-19 on global tuberculosis control efforts have been catastrophic, setting back by several years any progress being made in achieving the WHO End TB Strategy targets by 2030.
For the first time since 2015, the annual numbers of tuberculosis deaths have started increasing and more than 1.5 million people died of tuberculosis in 2020.
Furthermore, COVID-19 disruptions to health services have impeded diagnosing and treating everyone with active tuberculosis, drug-resistant tuberculosis, multidrug-resistant or extensively drug-resistant tuberculosis, latent tuberculosis, and tuberculosis and HIV co-infection, as well as access to tuberculosis medicines, counselling and follow-up, and lowered treatment adherence. This impedance in turn promotes the development of multidrug-resistant strains of tuberculosis and increases treatment failure rates, suffering, and death. Thus, in the foreseeable future, tuberculosis will continue to pose multiple challenges and negatively impact on already fragile health systems in countries with a high burden of tuberculosis.
Global emergency
The theme for this year's World Tuberculosis Day is “Invest to End TB. Save Lives'”. Although this theme is appropriate to refocus attention from COVID-19 to tuberculosis, it is a difficult task to achieve. The call for donors to invest more to end tuberculosis is again sadly familiar, yet essential because strategies for holding governments accountable and that advocate for increased investments have been in place ever since WHO declared tuberculosis a global emergency in 1993.
It is unlikely that in light of the poor global economic situation, major financial commitments to global tuberculosis control programmes will be forthcoming. However, while the tuberculosis community awaits financial commitments, despair can be turned to hope through more creative and innovative ways of health services delivery. We already have all the tools required to achieve global tuberculosis control targets and much more can be achieved via new ways of working, innovative strategies, and using existing resources maximally. Over the past two years, several promising new developments in approaches to screening, diagnosis, and management for both tuberculosis and COVID-19, if skillfully used, aligned, and synergised, could overcome the negative effects of COVID-19 disruptions in health services for airborne infectious diseases. Several lessons learnt from COVID-19 responses, including innovative new ways of health services working, also provide a fresh approach to management of respiratory infectious diseases with overlapping clinical symptoms and signs. Several practical steps, using recently updated diagnostics, treatments, patient follow-up, and community care guidelines for both COVID-19 and tuberculosis, if immediately taken forward, could have a synergistic, enhancing, and multiplier effect. Thus, COVID-19 programme innovations and adaptations from within the COVID-19 response should be built upon, to enhance access to integrated, patient-centred tuberculosis services.
The ongoing COVID-19 mass testing and vaccination rollout in wealthy nations are the result of unprecedented financial investments, rapid research and development, collaborative science, and innovation in delivery systems. Diseases that affect wealthier nations receive immediate attention and the required funding is made available quickly. However, the history of tuberculosis, and now COVID-19, is one of scientific and medical advances, accompanied by political failure to invest appropriately in rolling them out to all in need. The issues of inequities in COVID-19 vaccine distribution to Africa and unfulfilled pledges by wealthier nations, highlights that more visionary leadership, coupled with serious investments, are required from national governments to make countries with a high burden of tuberculosis self-reliant. Continued disinvestments in Africa into both tuberculosis and COVID-19 resulting from lack of political will is unacceptable.
Countries that are highly endemic for tuberculosis have all the experience and knowledge on social, economic, and operational determinants that drive the tuberculosis epidemic. There is an urgent need for countries that are highly endemic with tuberculosis to move away from donor dependency and invest in resilient and sustainable health systems. This would provide reassurance to all tuberculosis stakeholders in this unprecedented COVID-19 era of uncertainty.
Tuberculosis-endemic countries should focus on revamping health services, recalibrating them, and making the health sector more inclusive of all other WHO-declared global emergencies.
The time is also now ripe for countries endemic with tuberculosis to build goodwill on the current global attention on COVID-19 to better address existing tuberculosis care models, One Health approaches to prevent future zoonotic pandemics and the burgeoning problem of global antimicrobial resistance.
(UN News, The Lancet)
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