Lessons can be learnt from Covid response to fight resurgence in tuberculosis

Covid has contributed to a rise in TB deaths. But while the pandemic has undermined so many aspects of global health management, it has shown that a better, alternative approach can exist, writes Samuel Lovett

An tuberculosis patient looks on while another one coughs on a bed in a ward of the TB Civil Hospital in Ahmedabad, India (AFP via Getty Images)

It’s both alarming and tragic, but should come as no surprise. Global deaths from tuberculosis have risen for the first time in more than a decade. After the pandemic hit - placing much of the world on pause - health services tackling other infectious diseases were always going to suffer.

Amid the need to respond rapidly to Covid-19, resources were funnelled away from vital testing and surveillance networks in some of the poorest countries on the planet. The delivery of drugs, healthcare equipment and vaccines was disrupted and delayed. And, caught in one lockdown after another, those ill with life-threatening conditions struggled to access local services and treatment.

The impact on the global management of TB has been “particularly severe,” according to a new report from the World Health Organisation. Director-general Dr Tedros Adhanom Ghebreyesus said the findings of the research “confirms our fears” that the Covid pandemic “could start to unravel years of progress against tuberculosis”.

The report paints a grim picture. Along with the rise in deaths - up from 1.4 million in 2019, to 1.5 million last year - new diagnoses fell from 7.1 million to 5.8 million over the same period. Estimates suggest the number of undiagnosed TB sufferers increased by 1.2 million. Fewer individuals accessed preventative treatment. Global spending on TB services fell by £400m. The list goes on.

As a treatable and curable infection, it remains a source of shame that tuberculosis continues to plague humanity in the way that it does. The burden of death and disease is highest in just 30 countries, the majority of which, unsurprisingly, are lower- and middle-income in status. In essence, it is the poorest who pay the price for the world’s mishandling of the disease.

In recent years, accusations have rightly been levelled against Big Pharma that more should be done to increase accessibility to important testing kits in high-burden countries. Following the WHO’s announcement on Thursday, the international charity Medecins Sans Frontieres took aim at one US pharmaceutical, Cepheid, for pricing its “life-saving test out of reach” for many of the worst-hit TB nations.

“MSF is providing TB testing and treatment in 38 countries, and we do not accept that people with TB are unable to access the diagnostic tests they need because companies like Cepheid prioritise profit over saving lives,” the charity said.

It’s a similar argument that has been raised in the context of Covid, that the vaccines produced by the likes of Moderna and Pfizer are too expensive for poorer countries to afford. The manufacturers have faced calls to lift intellectual property rights on their products and share their vaccine blueprints with the rest of the world, but Big Pharma has clung to its defence that profits and patents need protecting for the sake of fuelling innovation - even in a once-in-a-lifetime pandemic that has killed millions.

There is a need for the world to do much better, in its approach to both coronavirus and tuberculosis. However, that the latter of these two diseases has now been displaced as the world’s deadliest infectious disease by Covid should not lessen the drive to eradicate it from the human population.

In reality, the global TB situation is only set to get worse. Modelling projections from the WHO suggest the number of people who develop and die from the disease could further rise in 2021 and 2022. Even before Covid, the world’s targets for tackling tuberculosis were off track.

Against the backdrop of disruption caused by Covid-19, it is asking a lot to not only keep up the fight against TB but intensify it in the years to come. There is no other option. The alternative is increased suffering and death for the world’s poorest, at a time when other infectious diseases are likely to be similarly surging.

Still, the response to Covid has demonstrated what is possible when the global community comes together as one. The world has moved at an unimaginable pace in developing vaccines and treatments, saving millions of lives in the process. Antiquated regulatory procedures and frameworks that stymied scientific advancement have been cast aside, accelerating the development of these medicines.

Giant leaps forward have been taken in the field of diagnostics, too. Covid tests that initially took three days to return a result can now confirm an individual’s status within a matter of minutes. What if the same urgency to develop this technology was applied within the testing of TB? Or the creation of new drugs? What breakthroughs could be achieved?

It is true that, in the context of Covid, the West has benefited most from such progression. But the pandemic has shown there is another way possible of fighting infectious diseases. As the shadow cast by tuberculosis looks set to grow, it is vital that the world does not turn its back on the lessons of the past 18 months and revert to its previous bad habits.