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Ending TB and COVID-19: We must leave no one behind – World TB Day 2021

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Guy Marks

Thanks to an unprecedented global mobilisation of resources, the tireless efforts of countless health and other frontline workers, and major scientific achievements, more and more countries are seeing the first glimpses of victory against COVID-19. But while Europe and North America are weeks or months into their immunisation campaigns, in most low- and middle-income countries, COVID-19 vaccines are only just arriving, and deployment is lagging.

As wealthier countries vaccinate their populations and begin to see hospitalisations and deaths fall, they must not neglect the pandemic in other parts of the world. Myopic, nationalistic approaches to global pandemics of communicable disease are doomed to fail. The familiar saying in the TB community, “TB anywhere is TB everywhere,” applies just as well to COVID-19.

For these reasons, The Union is proud to have signed onto the World Health Organization Vaccine Equity Declaration. The declaration calls on all countries to distribute vaccines equitably, and to begin vaccinating health and care workers as well as other at-risk populations within the first 100 days of 2021, among other commitments. We also call on other stakeholders to sign onto the declaration.

Success against COVID-19 is essential to our fight against TB. COVID-19 has set the fight against TB back an estimated 12 years, putting millions of lives in jeopardy. Data published in the International Journal of Tuberculosis and Lung Disease in January showed that in the state of Kerala, India, the mortality rate for people co-infected with TB and COVID-19 is a startling 15%, compared with 7.6% among all people with TB and 0.4% among all people with COVID-19. TB and COVID-19 is a lethal combination. Furthermore, in Kerala, as elsewhere, the COVID-19 pandemic has led to a steep decline in the number of people coming to clinics for diagnosis of TB. This decline in diagnosis, and hence treatment, of TB will have terrible consequences, not only for those in whom the diagnosis is delayed but for their family members and other contacts who have prolonged exposure to people with undiagnosed TB. The links between the two diseases calls for an integrated approach, including bi-directional screening for both diseases in areas with high TB burdens.

While we all yearn for an end to the COVID-19 pandemic, we cannot afford to return to the way things were before we ever heard the words “novel coronavirus.” As Dr. Grania Brigden, Director of The Union’s TB Department writes this week for New Scientist magazine, national leaders must prioritise public health on par with national security and economic matters. In the U.S., The Union and other organisations are advocating for $1 billion in annual resources for TB programmes—about a tripling over current funding levels. Other countries should follow suit. Given the impact of COVID-19 on the TB response, these new resources are critical to fulfilling the commitment to end TB by 2030.

With properly resourced TB programmes, we could achieve a lot with the current tools, rigorously and comprehensively applied to the whole population including screening, effective treatment for those people found to have TB and preventive treatment for those eligible. Coupled with widespread community and government support, stigma reduction activities and financial support for those affected, a formula for success can be achieved. Similar strategies have been used in the past and led to steep declines in the incidence of TB.

Now, as we recognise World TB Day, the anniversary of the discovery of the bacillus that causes TB, we are left with a major problem of TB in the rest of the world: 10 million cases of TB, of whom 1.4 million died, during 2019. While substantial investments in finding new cases, developing new tools and treating drug-resistant TB have been made, progress towards TB elimination is painfully slow. The lessons of past successes have yet to be learnt.

The clock is ticking. We need to finish the job of ending TB as a public health problem. Ending both COVID-19 and TB requires more intensive global cooperation and a marshalling of resources until every community is safeguarded from future outbreaks. On this World TB Day, we must redouble our efforts to find, treat and care for all people affected, leaving no one behind.


Guy Marks

President & Interim Executive Director of The Union