Is the tuberculosis response another victim of COVID-19?
On September 8, 2021, the report on the results of the 20th anniversary of the Global Fund to Fight AIDS, Tuberculosis and Malaria was published under a headline that sums up long-standing fears: “The COVID-19 pandemic has taken a devastating impact on the fight against HIV, tuberculosis and malaria in 2020 ”. This underscored the first decline in programmatic results in the history of the Global Fund. The magnitude of this impact on TB in 2020 was a 19% decrease in the number of people treated for drug-resistant TB in countries receiving Global Fund support and a 37% decrease in the number of people treated for extensively drug-resistant TB. . HIV saw an 11% drop in prevention programs and services, a 4.5% drop in the provision of treatment to prevent mother-to-child transmission, and a 22% drop in testing. Of the three major infectious diseases, malaria was the least affected. Prevention activities are stable or even improved; however, testing of suspected cases fell 4.3% and overall progress against malaria was described as stalled.
Over a year ago, in our editorial from June 2020, we highlighted the danger that COVID-19 posed for other programs: “The massive reallocation of resources to fight the pandemic has left little room for efforts underway to control other diseases, malaria and tuberculosis ”. Progress against all of these diseases is vitally important, but the TB community seems to have the hardest time being recognized for the damage caused by this disease. At the root of our concern at the time was a prediction from the Stop TB partnership on the impact COVID-19 would have on TB in high burden countries. They predicted that disruptions caused by the COVID-19 response would inevitably lead to increased morbidity and mortality in these settings, which they said would not return to pre-pandemic levels until at least 2025. The Global Fund report now makes it clear that these early concerns were well placed.
Although it is now commonplace, in June 2020 it should be stressed that the response to the COVID-19 pandemic had shown us that it was possible to mobilize the political will to act when the need arises. Yet that will has been elusive when it comes to tuberculosis despite the obvious need based on the massive morbidity and mortality still caused by the disease. The fact that the Global Fund provides 77% of all international funding for TB programs highlights that funding does not usually come from other sources. One way or another, tuberculosis is not generally seen as an urgent problem; given the international response to COVID-19, we know what an urgent response looks like. June 2020 was not the time to increase spending on TB control as so much effort was focused elsewhere, but it was always dangerous to assume that a major infectious disease could be left on its own when we let’s tackle a new priority. The COVID-19 pandemic is far from over, but we’ve never had the luxury of focusing on one challenge at a time.
COVID-19 has overtaken tuberculosis as the leading cause of infectious death, which, among other things, is a rock-solid justification for the resources that the pandemic response has attracted. But this unenviable status is unlikely to be a long-term situation, and at some point tuberculosis will regain its place. The question then will be whether the rationale that galvanized the enormous efforts in response to the COVID-19 pandemic will continue to apply to the “new” infectious disease responsible for the highest number of deaths in the world. The inequality in the global distribution of COVID-19 vaccines helps us answer this question: It is not the magnitude of the impact that guides action, but who is impacted. Unfortunately, for the TB community, it is primarily a disease affecting populations that have traditionally not been a priority for high-income countries.
The new Bill and Melinda Gates Foundation 2021 goalkeepers report highlights that the goal of ending TB by 2030 is not on track. It is hard to imagine that sufficient effort will be made by those countries best able to provide funds and other resources as they continue to fall inward on themselves with little or no immediate consequences. In June 2020, we asked why an infectious disease responsible for an average of 4,000 deaths per day did not warrant an emergency similar to the COVID-19 response. But the more pertinent question is why high-income countries, given recent experience, continue to delude themselves that major infectious diseases can be kept at bay.
For the Global Fund Results Report see https://www.theglobalfund.org/en/results/
For the Gates Foundation Goalkeeper Report see https://www.gatesfoundation.org/goalkeepers/report/2021-report/
© 2021 The author (s). Posted by Elsevier Ltd.