This pandemic has shown the devastating results of the world’s failure to invest in health: hospitals were overwhelmed, existing inequities were amplified, and people already living with preventable diseases, such as diabetes and hypertension, faced a higher risk of illness and death.
But the pandemic has also shown us what is possible: in some countries and cities, strong leadership and rapid, evidence-based response kept case numbers low and recovery in sight, and a remarkable concerted effort led to the development and approval of vaccines in less than a year. These successes offer hope, not just for this pandemic, but for the next one—and maybe even for one that has plagued humans for millennia: tuberculosis.
In 2014, TB overtook HIV as the world’s biggest infectious disease killer. Some 10 million people get sick with TB each year and it accounts for 1.4 million deaths, even though it is preventable and curable. Once a scourge of the industrialized west, today TB is a disease of poverty, mostly in low and middle income countries. And while covid-19 was the top infectious killer in 2020, TB deaths remain stubbornly high and are likely to increase in coming years because TB diagnosis and treatment, especially in high-burden countries such as India, Brazil, Peru and Indonesia dropped dramatically in 2020, reversing years of progress. Experts estimate as many as 400,000 additional TB deaths likely occurred in 2020 including among TB health care workers who were re-deployed to the covid-19 front lines.
It isn’t just TB that is likely to surge in the wake of this pandemic. Covid-19 has caused economic shocks that are likely to affect people’s health, economic status, and wellbeing for years to come. So, what have we learned from covid-19 that we can apply to other diseases, such as TB?
We’ve seen how fast the Access to COVID-19 Tools (ACT) Accelerator—set up by the WHO and partners—has facilitated the manufacture and delivery of 120 million high quality rapid antigen diagnostic tests to countries that lack the laboratory facilities or trained health workers to implement PCR tests. As many as 500 million tests are planned for distribution before October 2021. This feat was accomplished in months; by contrast, it took five years for a similar facility to produce the first WHO-approved rapid diagnostic test for HIV.
ACT has also supplied dexamethasone, a steroid that can help treat covid-19, for some three million patients in low-income countries, and has finalized an agreement that will enable future access to monoclonal antibody therapies in low- and middle-income countries.
ACT’s vaccines pillar— also known as COVAX—is working for global equitable access to covid vaccines, shining a light on the inequity of vaccine access between rich and poor countries thus far: 30 million vaccine doses have finally been distributed to low- and middle- income countries—compared to 100 million and counting in the United States alone—but it is clearly insufficient.
In a short time these global partnerships to address covid-19 have combined a brilliant mix of technologies, skills, and political commitment to achieve common goals driven by scientific reasoning that acknowledges just how interconnected we are: a failure to vaccinate or eliminate diseases in one country will have a knock-on effect everywhere else. We can, and must, apply the same approach to ending TB, and we must do it equitably, so those most in need are the first in line for new treatments and vaccines.
We do have a vaccine for TB. But the BCG vaccine, discovered 100 years ago, doesn’t prevent respiratory disease, which is the most common form of TB in adults, and is 70% to 80% effective against the most severe forms of TB, such as TB meningitis, in children. We’ve long needed a new and better one.
Diagnostic tools for TB are antiquated compared to those for other diseases. New medicines to cure TB are, for the most part, not a priority for drug development. Treatment takes months. Multidrug-resistant TB is a huge problem, and we can expect rates to rise in the wake of treatment interruptions due to covid-19.
Even beyond the need to end TB, this pandemic has shown us that, in a globalized world, we need a healthier global population overall. Noncommunicable diseases such as cancer and heart disease kill 71 million people a year, and can make people more susceptible to other diseases, such as covid-19.
Governments need to prioritise and invest in health—not just health care systems, but strong policies that promote prevention, control drivers of ill health such as air pollution tobacco, alcohol, and unhealthy food, and fight curable killers like TB. The covid-19 pandemic showed us what is possible when there is political will. In this interconnected world, none of us are safe until all of us are safe.
José Luis Castro is the President and CEO of Vital Strategies, a global health organization, and former ED of the International Union Against TB and Lung Disease.
Competing interests: none declared