Tuberculosis deaths and illnesses increase during COVID-19 pandemic
An estimated 10.6 million people fell ill with tuberculosis (TB) in 2021, a 4.5% increase from 2020, and 1.6 million people died from TB (including 187,000 among HIV-positive people), according to the World Health Organization’s 2022 World Tuberculosis Report. . The burden of drug-resistant tuberculosis (DR-TB) also increased by 3% between 2020 and 2021, with 450,000 new cases of rifampicin-resistant tuberculosis (RR-TB) in 2021. This is the first time since many years that an increase has been reported in the number of people with TB and drug resistant TB. TB services are among many disrupted by the COVID-19 pandemic in 2021, but its impact on the TB response has been particularly severe. Ongoing conflicts in Eastern Europe, Africa and the Middle East have further aggravated the situation of vulnerable populations.
“If the pandemic has taught us anything, it’s that with solidarity, determination, innovation and the fair use of tools, we can overcome serious health threats. Let’s apply these lessons to TB. It’s time to put an end to this longtime killer. By working together, we can end TB,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO.
Ongoing challenges in providing and accessing essential TB services have resulted in many people with TB going undiagnosed and untreated. The reported number of people newly diagnosed with TB increased from 7.1 million in 2019 to 5.8 million in 2020. There was a partial recovery to 6.4 million in 2021, but this was still well below the pre-pandemic levels.
Reductions in the reported number of people diagnosed with TB suggest that the number of people with undiagnosed and untreated TB has increased, leading first to increased TB deaths and increased community transmission of TB. infection and then, with a certain lag, an increase in the number of people developing tuberculosis.
The number of people receiving treatment for RR-TB and multidrug-resistant TB (MDR-TB) also decreased between 2019 and 2020. The reported number of people starting treatment for RR-TB in 2021 was 161,746, or approximately one in three of the people in need.
The report notes a decline in global spending on essential TB services from US$6 billion in 2019 to US$5.4 billion in 2021, less than half of the global target of US$13 billion. US dollars per year by 2022. As in the previous 10 years, most funding used in 2021 (79%) came from domestic sources. In other low- and middle-income countries, funding from international donors remains crucial. The main source is the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The United States government is the largest contributor to funding for the Global Fund and is also the largest bilateral donor; overall, it contributes nearly 50% of international donor funding for TB.
“The report provides important new evidence and makes a strong case for the need to join forces and urgently redouble our efforts to get the TB response back on track to meet tuberculosis targets. tuberculosis and save lives”, said Dr Tereza Kasaeva, director of the WHO Global Tuberculosis Program. “It will be an essential tool for countries, partners and civil society as they review progress and prepare for the 2nd UN High-Level Meeting on TB scheduled for 2023.”
Amid the stalled progress, there are some successes. 26.3 million people were treated for TB between 2018 and 2021, still far from the 40 million target set for 2018-2022 at the UN High Level Meeting on TB. Among the 30 high TB burden countries, those with the highest levels of treatment coverage in 2021 were Bangladesh, Brazil, China, Uganda and Zambia. The number of people receiving preventive treatment for TB rebounded in 2021 to approach 2019 levels, but the cumulative total of 12.5 million between 2018 and 2021 was still far from the target of 30 million at the end of the year. end of 2022.
More positively, TB preventive treatment for people living with HIV far exceeded the global target of 6 million over the period 2018-2022, reaching over 10 million in just 4 years. Seven countries – India, Nigeria, South Africa, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe – collectively accounted for 82% of people who started preventive treatment in 2021.
Seven high-burden countries in the region – Ethiopia, Kenya, Lesotho, Namibia, South Africa, United Republic of Tanzania and Zambia – have reached or surpassed the 2020 milestone d a 20% reduction in the incidence rate of tuberculosis compared to 2015.
Countries are also increasing uptake of new WHO-recommended tools and guidance, resulting in earlier access to TB prevention and care and better outcomes. The proportion of people diagnosed with TB who were initially tested with rapid diagnosis increased from 33% in 2020 to 38% in 2021. 109 countries were using longer all-oral regimens (up from 92 in 2020) for the treatment of MDR/RR-TB, and 92 used shorter regimens (compared to 65 in 2020).
There has been increased access to shorter (1-3 month) rifamycin-based regimens for TB preventive treatment. In 2021, 185,350 people in 52 countries were reported to have been treated with regimens containing rifapentine, compared to 25,657 in 37 countries in 2020.
The report reiterates its call for countries to put in place urgent measures to restore access to essential TB services. It further calls for increased investment, multisectoral action to address the broader determinants that influence TB epidemics and their socio-economic impact, as well as the need for new diagnostics, drugs and vaccines. To scale up vaccine development, building on lessons learned from the pandemic, WHO will convene a high-level summit in early 2023.
The 2022 report presents data on disease trends and outbreak response from 215 countries and territories, including all 194 WHO Member States.
Note to Editor
Global TB targets
In 2014 and 2015, all WHO and UN Member States adopted the United Nations Sustainable Development Goals (SDGs) and the WHO Strategy to End TB. Both the SDGs and the TB Strategy include targets and milestones for significant reductions in TB incidence, TB deaths and costs faced by TB patients and their families. .
In 2018, countries meeting at the United Nations (UN) High-Level Meeting on Tuberculosis pledged to accelerate work towards ambitious targets to treat 40 million more people with TB and provide preventive treatment to at least 30 million people at risk of developing the disease. illness by 2022.
Tuberculosis, the second deadliest infectious killer (after COVID-19), is caused by a bacterium (Mycobacterium tuberculosis) that most commonly affects the lungs. It can be spread when people with TB expel bacteria into the air, for example by coughing.
Most people who develop the disease are adults – in 2021 – men accounted for 56.5% of the TB burden, adult women 32.5% and children 11%. Many new cases of tuberculosis are attributable to five risk factors: undernutrition, HIV infection, alcohol use disorders, tobacco use and diabetes.
Tuberculosis is preventable and curable. About 85% of people who develop TB disease can be successfully treated with a 4/6 month drug regimen; treatment has the added benefit of reducing onward transmission of infection.
Economic and financial barriers can affect access to health care for TB diagnosis and completion of TB treatment; about half of TB patients and their families face catastrophic total costs due to TB disease. Progress towards universal health coverage (UHC), better levels of social protection, and multisectoral action on the broader determinants of TB are all essential to reducing the burden of TB.
Although TB is present in all regions of the world, 30 countries bear the heaviest burden. These include: Angola, Bangladesh, Brazil, Central African Republic, China, Congo, Democratic People’s Republic of Korea, Democratic Republic of Congo, Ethiopia, Gabon, India, Indonesia, Kenya, Lesotho, Liberia, Mongolia, Mozambique , Myanmar, Namibia, Nigeria, Pakistan, Papua New Guinea, Philippines, Sierra Leone, South Africa, Thailand, Uganda, United Republic of Tanzania, Viet Nam and Zambia.