WHO reports increase in TB deaths during pandemic

Drug-resistant cases of the deadly disease also rose between 2020 and 2021

A patient suffering from TB receives medical treatment at a hospital in Peshawar, Pakistan. EPA

The number of people who fell ill and died with tuberculosis increased during the coronavirus pandemic, the World Health Organisation said on Thursday.

An estimated 10.6 million people fell ill with TB in 2021, an increase of 4.5 per cent from 2020, and 1.6 million people died from the disease, according to the WHO's 2022 Global TB report.

Drug-resistant TB also increased by 3 per cent between 2020 and 2021, with 450,000 new cases of rifampicin-resistant TB last year.

This is the first time in many years an increase has been reported in the number of people falling ill with TB and drug-resistant TB.

TB services, among many others, were disrupted by the pandemic last year, with the impact on the TB response particularly severe. Conflicts across Eastern Europe, Africa and the Middle East have further exacerbated the situation for vulnerable populations.

“If the pandemic has taught us anything, it’s that with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threats,” said Dr Tedros Adhanom Ghebreyesus, WHO's director general.

“Let’s apply those lessons to tuberculosis. It is time to put a stop to this long-time killer. Working together, we can end TB.”

Missed TB diagnoses

Challenges in providing and accessing essential TB services have meant that many with TB were not diagnosed and treated.

The reported number of people newly diagnosed with TB fell 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 pre-pandemic levels.

Reductions in the reported number of people diagnosed with TB suggest that the number with undiagnosed and untreated TB has grown, resulting first in an increased number of TB deaths and more community transmission of infection, and then, with some time lag, increased numbers of people developing TB.

The number of people provided with treatment for rifampicin-resistant TB and multidrug-resistant TB also declined between 2019 and 2020. The reported number of people started on treatment for rifampicin-resistant TB last year was 161,746 — only about one in three of those in need.

TB spend reduction

The report notes a decline in global spending on essential TB services from $6 billion in 2019 to $5.4 billion in 2021, which is less than half of the global target of $13 billion annually by 2022.

As in the previous 10 years, most of the funding used in 2021 (79 per cent) was from domestic sources.

In other low- and middle-income countries, international donor funding remains crucial. The main source is the Global Fund to Fight Aids, Tuberculosis and Malaria (the Global Fund).

The US government is the largest contributor of funding to the Global Fund and is also the largest bilateral donor. Overall, it contributes nearly half of international donor funding for TB.

TB successes

In the midst of stalling progress, there were some successes.

A total of 26.3 million were treated for TB between 2018 and 2021, still far short of the 40 million target set for 2018—2022 at the UN High-Level Meeting on TB.

Of the 30 high TB burden countries, those with the highest levels of treatment coverage in 2021 included Bangladesh, Brazil, China, Uganda and Zambia.

The number of people provided with TB preventive treatment rebounded in 2021 to close to 2019 levels, but the cumulative total of 12.5 million between 2018 and 2021 was far from the target of 30 million by the end of 2022.

More positively, TB preventive treatment for people living with HIV has far surpassed the global target of 6 million in the period 2018-2022, reaching more than 10 million in only four years.

Seven countries — India, Nigeria, South Africa, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe — collectively accounted for 82 per cent of those started on preventive treatment in 2021.

Seven high TB burden countries in the region — Ethiopia, Kenya, Lesotho, Namibia, South Africa, the United Republic of Tanzania and Zambia — have reached or surpassed the 2020 milestone of a 20 per cent reduction in the TB incidence rate compared with 2015.

Countries are also increasing the uptake of new tools and guidance recommended by WHO, resulting in early access to TB prevention and care, and better outcomes.

The proportion of people diagnosed with TB who were initially tested with a rapid diagnostic increased from 33 per cent in 2020 to 38 per cent last year.

WHO call to action

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 socioeconomic impact, as well as the need for new diagnostics, drugs and vaccines.

To intensify vaccine development, building on lessons from the pandemic, the WHO will be convening a high-level summit in early 2023.