The TB community in 2021—tired, frustrated, but hopeful

The TB community continues to tackle one of the world’s oldest epidemics while struggling with the newest one, writes Catherine Berry

The year 2020 was like no other. And the tuberculosis (TB) community is tired. Much of last year was spent managing covid-19 and trying to keep existing services going. TB diagnostics were diverted, supply chains interrupted, and lockdowns meant getting to appointments and even picking up drugs was impossible for many patients. Like the rest of medicine, TB didn’t go away but covid made it so very much harder—from diagnosis to the way people living with TB took treatment. 

The TB community is astounded. Tired but astounded. We watched the mobilisation of researchers looking for treatments and vaccines for covid-19, backed by resources we’ve only dreamed of. Adaptive trials like RECOVERY and REMAP-CAP reported results within the year—steroids were able to save countless lives. We now have not just one, but multiple safe and effective vaccines for covid-19. The masks that we have long struggled to get people to wear became the norm and even the law in some places. The debate around infection control and protection of healthcare workers has been unprecedented. There is now more research into how the BCG vaccine might protect against covid-19 than into its effect on TB.

The TB community is frustrated. Tired, astounded, but frustrated. Because a stark reality is now before us: 

  • In 2020, more than one million people globally died from covid-19.
  • Because of the research and the investment and the mobilisation of communities, this is unlikely to be repeated in 2021.
  • So when will we be able to say the same for TB?

Today, we come closer to realising a dream which started almost 10 years ago: that all TB patients could be cured with no more than six months of treatment, whether they had drug sensitive or drug resistant disease. Last week, the TB-PRACTECAL stopped recruitment for its trial after the bedaquiline, pretomanid, and linezolid (BPaL) plus moxifloxacin arm showed superiority for patients with multidrug resistant TB and pre-extensively drug resistant TB. While we await the final peer reviewed results, it’s likely to be an important piece in a complex puzzle. Along with four month treatments for drug sensitive TB and one to three month treatments for latent TB, it’s becoming clear that for TB, as for many other bacterial diseases, short course treatments are better.

So, in spite of everything, the TB community is inspired. We continue to tackle one of the oldest epidemics while struggling with the newest one. We are ambitious and no longer willing to settle for distant targets long into the future. We need diagnostics, new drugs, and a good biomarker that tells us when patients are cured so they don’t need treatment a moment longer than is necessary. We need something better than the 100 year old vaccine we still rely on. We need to help break down stigma. We need to support people living with TB financially through treatment and give them the dignity they deserve.

So our call—to governments, researchers, communities—is this: join us. Better is no longer enough. This needs to end. 

Catherine Berry is a medical monitor for TB-PRACTECAL. She is an infectious diseases physician and conjoint lecturer with the University of Newcastle with a special interest in MDR-TB and antimicrobial resistance. She joined MSF in 2014, working on projects in Uzbekistan, Belarus, South Africa, and Jordan. Twitter @catherineeberry

Competing interests: none declared.