World TB Day is marked on 24 March, and this year, the World Health Organization (WHO) has called for urgent investment in the fight against tuberculosis, “to save millions more lives”.

Although TB is preventable and curable, it remains one of the world’s deadliest infectious killers, WHO noted on Wednesday.

“For the first time in over a decade, WHO has reported an increase in tuberculosis deaths. This is a very dangerous trend that we must arrest. We call on all countries to invest in expanding access to effective tools against tuberculosis, and in new tools to #EndTB“-@DrTedros

— World Health Organization (WHO) (@WHO) March 23, 2022

Each day, it claims more than 4,100 lives, and close to 28,000 people fall ill after becoming infected – and this, despite the fact that 66 million lives have been saved since 2000.

The UN health agency pointed out that global spending on TB diagnostics, treatments and prevention in 2020 was less than half the annual global target of $13 billion.

For research and development, an extra $1.1 billion per year is needed.

“Urgent investments are needed to develop and expand access to the most innovative services and tools to prevent, detect and treat TB that could save millions of lives each year, narrow inequities and avert huge economic losses,” said WHO Director-General, Tedros Adhanom Ghebreyesus.

“These investments offer huge returns for countries and donors, in averted health care costs and increased productivity.”

Conflicts push up deaths

The need for global action is more urgent than ever, the WHO said, as the COVID-19 pandemic has reversed years of progress in preventing TB transmission, meaning that for the first time in over a decade, tuberculosis deaths increased in 2020.

Conflicts across Eastern Europe, Africa and the Middle East, have made vulnerable populations more susceptible to TB, underscoring the need to ensure that commitments made by global leaders to end TB are met.

“Investments in TB programmes have demonstrated benefits not just for people with TB but for health systems and pandemic preparedness,” WHO said. “Building on lessons learnt from COVID-19 research, there is a need to catalyse investment and action to accelerate the development of new tools, especially new TB vaccines.”

Funding shortfall

Progress towards reaching current TB targets including the WHO Director-General’s “Find.Treat.All” is at risk mainly from a lack of funding.

Between 2018 and 2020, 20 million people received TB treatment. This is halfway to the five-year target which ends in 2022. During the same period, 8.7 million people received TB preventive treatment. This is only 29 per cent of the target of reaching 30 million from 2018 to 2022.

A laboratory technician in Bangladesh manipulates multi drug resistance tuberculosis (MDRT) samples. Photo: The Global Fund/Thierry Falise

The Global Fund/Thierry Falise

A laboratory technician in Bangladesh manipulates multi drug resistance tuberculosis (MDRT) samples. Photo: The Global Fund/Thierry Falise

The situation is even worse for children and adolescents with TB, WHO warned.

In 2020, an estimated 63 per cent of children and young adolescents with TB were not reached, or not officially reported to have accessed life-saving TB diagnosis and treatment services.

The proportion was even higher (72 per cent) for under fives, according to the UN health agency, which said that almost two-thirds of eligible children under five did not receive TB preventive treatment and therefore remain at risk of falling sick.

New recommendations

To expand cover to populations most at risk from TB, WHO has issued new patient-centred recommendations to boost diagnosis, treatment and prevention. These include that:

  • Diagnostic testing should now include non-invasive methods, such as stools.
  • Rapid molecular diagnostics should be the initial test for TB diagnosis among children and adolescents.
  • Children and adolescents who have non-severe forms of drug-susceptible TB should be treated for four months instead of six months.
  • For TB meningitis, a six-month regimen is now recommended, instead of 12 months, to reduce the cost for families.
  • Two of the newest TB medicines to treat drug resistant TB (bedaquiline and delamanid) are recommended for use in children of all ages, making it possible for children with drug-resistant TB to receive all-oral treatment regimens, regardless of their age.
  • TB care should be decentralized so that more children and adolescents can access care or preventive treatment closer to home.