Before the COVID-19 pandemic struck such a ferocious blow to the global health community, there was a trend in the right direction in eradicating other longstanding infectious diseases. According to the World Health Organization (WHO), between 2015 and 2020, global tuberculosis (TB) incidence fell by 11%.
Now, unfortunately, it seems that we’re losing that hard earned progress as resources and attention are redirected toward battling the coronavirus. The WHO reports that there were 1.5 million TB deaths last year, a figure which has risen for the first time in a decade. Far fewer people among vulnerable communities are being diagnosed, treated, or provided with preventative assistance, while newly published research indicates that TB bacteria can be transmitted via aerosols, upending many long-held assumptions about prevention.
This is a significantly worrying development that requires urgent attention. However, there still lacks urgency among leadership that could result in serious consequences.
This year marked the centenary of the Bacillus Calmette–Guérin (BCG) vaccine, which remains the only TB vaccine available. New TB vaccines are in the pipeline but compared to the COVID-19 vaccine, progress has been slow and underfunded. So where is the funding? In 2018, Global tuberculosis R&D expenditures totalled $906 million, with the public sector contributing more than two-thirds, or $617 million, of total TB research spending. In contrast, 2020 COVID-19 expenditures for development in the U.S. alone, exceeded more than $9 billion.
It comes as no surprise to those of us in the global health space that the poorest countries continue to carry the highest burden of TB infection. High-income countries have achieved drastic reductions in TB incidence through a combination of improved living standards and dedicated public health infrastructure and resources. Yet, the disease continues to devastate marginalized populations in low- and middle-income countries, for whom optimal TB care is often deemed “impractical” and not “cost-effective”.
Although TB is a global concern, it disproportionately impacts the South-East Asian Region, with 43% of new cases, followed by the African Region, with 25% of new cases and the Western Pacific with 18%, according to the WHO. In comparison, the U.S., Canada, Australia & New Zealand have among the lowest rates with an incidence rate of less than 10 cases per 100,000 population, per year.
This disproportionate impact might explain why wealthy countries are not prioritizing efforts to treat, vaccinate, and research diseases like TB which do not largely impact their populations. However, it would be misguided to assume that global health is not inextricably linked to the moral obligation and economic health of all nations. Decision makers across the globe must recognize our interconnectedness and shared responsibility to forge better health outcomes for all.
The economic health of a nation insists upon a healthy populace wherein business is conducted. For example, the U.S. goods exports to the Association of Southeast Asian Nations (ASEAN) in 2020 were $76.4 billion, down 11.2% ($9.7 billion) from 2019. Similarly, U.S. trade in goods throughout Africa in 2020 saw sharp downturns as compared to 2019. Pandemics prove how fragile our systems are: global commerce and supply chains don’t run without people– healthy people– managing them. We might face a similar fate if wealthy nations do not start treating TB as seriously as the COVID-19 pandemic.
In decreasing resources to TB, the private sector and wealthy countries all but ensured an increase in mortality. Herein lies our moral obligation. If we know decreases in spending result in significant loss of human life, how can we possibly push on the brakes?
“COVID-19 vaccine inequity and the failure to come up with a vaccine for tuberculosis are two sides of the same coin – a devaluation of human life in poor countries,” said The Union President Guy Marks, at the 52nd Union World Conference on Lung Health. “Until COVID-19 came along, TB was killing more people than any other infectious disease but you’d never know it. If we had spent a fraction of the energy and money that governments and pharma have spent developing COVID-19 vaccines and then getting them to wealthy countries, we´d have stopped TB long ago.”
Looking ahead, we must set the stage for an ambitious and successful Global Fund replenishment; push for the Global Fund to play a central role in patient-provider relationships; mobilize resources for TB to recover from the impact of COVID-19; and find the political will to implement policies which are truly vested in equitable health outcomes. We need a recovery plan to get back on track to reach UN HLM TB targets and SDG commitments to end TB by 2030 that embodies an integrated approach to tackle interrelated diseases and epidemics, such as COVID-19 and TB.
COVID-19 has made public health a priority on the political agenda, but it must remain a priority after the pandemic. The global health policy community and funding mechanisms must leverage this momentum to strengthen the overall TB response. Simply, we need to take the fight against TB more urgently and seriously. This must include learning to plan for and fund simultaneous health crises. New viruses aren’t going away anytime soon, but perhaps with newfound global commitment to rising death tolls, we can end the other hundred-year-war, and finally, eliminate tuberculosis.
About the authors:
Vineeta Gupta, MD, JD, LLM: Dr. Gupta, Director, Action Secretariat, is a trained physician and human rights lawyer and lifelong advocate providing expertise and thought leadership at the nexus of the most critical issues in the fields of health equity, RMNCAH, women’s rights, and global health. She has conducted workshops on diversity, inclusion, and health disparities and has been invited to speak in over 60 universities in the U.S and Europe. She is widely covered in print and online media globally, including Washington Post, The Economic Times, The Hindu, Times of India, Hindustan Times, China Daily, NPR, US News and World Report, FOX news, and CNN.
Allan Ragi: A specialist in public health with experience in national policy development, capacity building, and networking community service organizations, Mr. Allan Ragi has over 35 years of experience working in public health. Allan is currently the executive director of Kenya AIDS NGOs Consortium (KANCO).
Competing interests: None
Handling Editor: Neha Faruqui