Every March 24, the World Tuberculosis (TB) Day is commemorated to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global epidemic.
Marking the event, the World Health Organisation (WHO) said the theme of the World TB Day 2021 – ‘The Clock is Ticking’ – conveys the sense that the world is running out of time to act on 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,” the WHO said in a statement Tuesday.
While efforts to end COVID-19 have continued to gather steam with the successful roll out of vaccines in several countries, health experts believe the pandemic’s ripple effect – disrupting other health targets – will have an adverse impact on the treatment and prevention of tuberculosis.
The UN Sustainable Development Goals aim to end TB by 2030 but progress in the last few years have been slowed by poor funding and now by COVID-19.
The 2020 global report on TB released by WHO highlighted poor funding as a major challenge in reaching the 2022 TB target of treating 1.5 million people with multidrug-resistant TB — or MDR TB — by the end of 2022. The rise of MDR TB has posed another threat in the battle against the infectious disease.
Efforts have shifted from tracking TB cases to tracing people infected with COVID-19 as manpower, equipment and budgets are reassigned, a recent investigation by WHO revealed.
As a result, millions of tuberculosis diagnoses have been missed, and according to the WHO this is likely to result in 200,000 to 400,000 excess deaths from the disease in 2020 alone, with a further million new cases occurring every year after that for the next five years if urgent measures are not taken.
One year of COVID-19 resulted in nearly a 25 per cent decrease in diagnosis and treatment of tuberculosis around the world, according to a recent survey by Stop TB Partnership, reversing almost 12 years of global progress against tuberculosis.
“Twelve years of impressive gains in the fight against TB – including in reducing the number of people who were missing from TB care – have been tragically reversed by another virulent respiratory infection,” said Stop TB Partnership’s executive director, Lucica Ditiu, the Guardian UK reported.
Latest data from WHO from more than 80 countries, showed a reduction in treatment of TB by 21 per cent in the first year of the pandemic, compared with 2019.
This means that about 1.4 million people lost out on treatment for TB in 2020 compared with the previous year, because of COVID-19.
“The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the world’s poorest people, who were already at higher risk for TB,” said Tedros Ghebreyesus, WHO Director-General.
“These sobering data point to the need for countries to make universal health coverage a key priority as they respond to and recover from the pandemic, to ensure access to essential services for TB and all diseases.”
TB and COVID-19
Every year, TB infects 10 million people and kills 1.5 million, more than any other infectious disease. Although COVID-19 overtook TB in 2020 as the most common cause of death from an infectious disease, tuberculosis still kills more people in low and middle-income countries like Nigeria.
Because they have similar symptoms and transmission mode, health experts say the spike in TB infections and the COVID-19 outbreak could be robbing off on each other, making treatment for both diseases even harder.
People living with TB are especially vulnerable to the coronavirus, making hindrance to treatment and testing worrisome, health experts say.
Caused by a bacterium known as Mycobacterium tuberculosis, TB most often affects the lungs, and like COVID-19 can spread from person to person through the air when infected people cough, sneeze or spit.
Tuberculosis symptoms can be very similar to those for COVID-19 — a dry cough, fever, fatigue, and trouble breathing — which can lead to people with TB not receiving testing for COVID-19.
Though they have several similarities, one of the clearest difference in the impact of both diseases can be seen in the global attention towards ending them.
While there are about a dozen vaccines for COVID-19 already certified for global use just within a year and almost 100 types of diagnostic tests, the most common TB vaccine is roughly 100 years old and there are just two tests for TB.
“I hope we buckle up and smartly address, at the same time, TB and COVID-19 as two airborne diseases with similar symptoms”, said Mr Ditiu of the Stop TB Network.
High burden of TB in Nigeria
Nigeria remains one of the 30 countries globally with the highest burden of the disease, ranking high among nations with a high burden of TB, TB/HIV and Multidrug-resistant TB.
In 2019, Nigeria came third behind only India and China among eight countries that accounted for two-thirds of the new TB cases globally, according to WHO.
Nigeria also ranks first in Africa with the highest number of undetected cases of TB.
A 2020 prediction model by the KNCV Challenge TB project showed that Nigeria has at least 70 possible tuberculosis hotspots which are yet to be detected.
Statistics from WHO showed that every year, around 245,000 Nigerians die from tuberculosis (TB) and about 590,000 new cases occur (of these, around 140,000 are also HIV-positive).
Many low and middle-income countries such as Nigeria have been depending on international funding for TB intervention with 73 per cent coming from the Global Fund, a funding mechanism that pools the world’s largest financial donations for the prevention and treatment for HIV, TB and Malaria.
While the Global Fund has managed to continue making financial contributions towards ending TB in high-burden countries despite the economic downturn of the pandemic, management of such funds have been tainted with fraudulent practices.
PREMIUM TIMES in 2019 reviewed a Global Fund audit report that covered the period between January 7 and December 17, 2018. The report revealed how aid money disappeared in the hands of corrupt officials in seven African countries including Nigeria.
In the report, the national coordinator of the Civil Society for the Eradication of Tuberculosis in Nigeria (TB Network) was indicted for orchestrating a scheme to misappropriate funds amounting to $51,038.
In Nigeria, prevention activities were also cancelled or delayed due to COVID-19.
Results from Global Fund’s latest biweekly survey showed that 20 per cent of HIV and TB lab services are experiencing high disruptions as staff are being reassigned to COVID-19.
“At the current rate, COVID-19 is killing about the same number of people every month as HIV, tuberculosis and malaria combined. However, the death toll from these three diseases will have increased as a result of the knock-on impacts from the COVID-19 pandemic, due to lockdowns, resources diverted to the new virus, and interruptions to lifesaving services”, said Peter Sands, Executive Director of the Global Fund.
On Wednesday — World Tuberculosis Day — WHO reignited its call on countries to accelerate efforts to provide preventive treatment to people infected with TB while tackling COVID-19.
The global health agency urged governments to join in making the following renewed commitments towards ending TB:
- Accelerate the End TB Response to reach the targets set in Sustainable Development Goals, WHO End TB Strategy, the Moscow Declaration to End TB and the political declaration of the UN High-Level Meeting on TB.
- Diagnose and treat 40 million people with TB by 2022 including 3.5 million children and 1.5 million people with drug-resistant TB. This is in line with WHO’s overall drive towards Universal Health Coverage and the WHO Director General’s flagship initiative “Find. Treat. All. #EndTB” jointly with the Global Fund and Stop TB Partnership.
- Reach 30 million people with TB preventive treatment by 2022 so that those people most at risk receive TB preventive treatment, including 24 million household contacts of TB patients – 4 million of whom are children under 5 – and 6 million people living with HIV.
- Mobilize sufficient and sustainable financing to reach USD 13 billion a year to support efforts to end TB; for every USD 1 invested to end TB, USD 43 is returned as the benefits of a healthy functioning society (Economist/ Copenhagen Consensus).
- Invest in TB research to reach at least USD 2 billion a year for better science, better tools and better delivery.
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