Last week, two years after the UN High Level Meeting (UNHLM) on Tuberculosis, the WHO and partners released a progress report to take stock of progress made in meeting the WHO’s End TB strategy, Sustainable Development Goals, and UNHLM targets for TB.
The report was released at the 75th Session UN General Assembly (UNGA) side event on September 23 and presented by WHO Director-General Dr Tedros Adhanom Ghebreyesus. He made a strong call to action, saying that “Accelerated action is urgently needed worldwide, if we are to meet our targets by 2022.”
About COVID-19's effect on TB, he added: “The COVID-19 pandemic threatens to unwind the gains we have made. The impact of the pandemic on TB services has been severe.”
With 1.4 million deaths and 10 million new cases in 2019, TB was the top infectious disease killer globally last year, a role it continues to hold even during COVID-19 according to Ms Blessina Kumar, member of the WHO Civil Society Taskforce on TB.
Three key events in the world’s fight against tuberculosis are:
The End TB Strategy includes targets to reduce TB incidence by 20% and reduce TB deaths by 35% between 2015 and 2020. According to the progress report TB incidents worldwide only decreased by a meagre 9% between 2015 and 2019, and TB deaths by only 14%.
Another critical target in the End TB Strategy is that no TB-affected family should face catastrophic costs due to TB. The strategy's defines catastrophic costs as total TB care costs exceeding 20% of annual household income. Last year, almost half of all people (49%) who fell ill with TB faced catastrophic costs due to their illness.
The world is also behind on reaching the UNHLM’s targets for increased funding and treatment. In 2018, the GA pledged US$ 13 billion annually in funding for universal access to TB prevention, diagnosis, treatment, and care by 2022. This year, the global budget for these TB activities amounted to US$ 6.5 billion, half of the target sum. Additionally, the target to allocate US$ 2 billion annually to TB research by 2018-2020 has not been met. In 2018, only 908 million was spent on TB research globally.
At the UNGA, Ms Blessina Kumar made a passionate call for greater investment, accountability, and research to end TB. "Invest, invest, invest", she said, and continued: “TB funding has reduced significantly, especially in the past 6-8 months, while at the same time billions of dollars have been made available for COVID-19. This is indeed great for COVID-19. But not at the cost of TB.”
In the context of the global TB epidemic, COVID-19 threatens to reverse recent progress towards global TB targets.
Speaking at the UNGA, Dr Tereza Kasaeva, Director of WHO’s Global TB Programme, presented a WHO analysis on the impact of COVID-19 on TB deaths. The model indicates that a 50% drop in TB case detection over three months could lead to an increase in the number of TB deaths worldwide by between 200,000 and 400,000 in 2020 alone.
Earlier this month, several civil society organisations working on TB released the results of a large survey done to document the impact of the pandemic on TB care, research, and funding. The document shows that an increase of 200,000 deaths would take the world back to 2015 levels and an increase of 400,000 to 2012 levels.
Efforts to end TB are off track and were so even before COVID-19. To get back on track, WHO and partners are urging countries to implement the following ten priority recommendations to put the world on track to reach agreed targets by 2022 and beyond:
Overall, the report shows that although progress continues to be made, at the current pace it remains unlikely that 2035 targets will be met. Much more intensive efforts to find, cure, and prevent all cases of TB are necessary to meet global goals and end the public health burden of TB.
The 2020 Progress Report will inform a comprehensive review at a High Level Meeting on TB in 2023.