Devex CheckUp: Back at the top. TB returns as leading infectious killer

The latest Global Tuberculosis Report is out, and it confirms what experts have predicted: TB is back in the top spot as the world’s leading infectious killer, after being displaced by COVID-19 during the pandemic. TB caused 1.25 million deaths in 2023, almost double the deaths due to HIV and AIDS.

But TB funding has gotten even smaller. It’s at $5.7 billion, down from $6 billion annually in 2020 to 2022. This is due to a decline in domestic resources. The problem is that about half of households affected by TB are already facing catastrophic health costs, far from the World Health Organization target of 0% by 2025.

Still, eliminating TB entirely remains possible.

“It's absolutely doable. It's just that it's hard work, and unfortunately, it's expensive,” Dr. Cassandra Kelly-Cirino, who took the helm of the membership organization widely known as The Union in early October, tells my colleague Jenny Lei Ravelo.

The Global Fund to Fight AIDS, Tuberculosis and Malaria provides 76% of the international funding for TB. But several advocates are pushing the fund to increase its allocation, as TB currently receives far less from the fund than malaria or HIV.

But there is some good news. The number of people newly diagnosed with TB reached a record high since WHO started monitoring the global TB situation in 1995. This has reduced the estimated number of people with undiagnosed and unreported TB from about 4 million during COVID-19 to 2.7 million. That remains a sizable number, though. One challenge is that many people are still being diagnosed with old tools that have low TB sensitivity and that cannot diagnose drug-resistant strains of the disease.

Read: New The Union head says eliminating TB ‘doable’ but ‘expensive’ (Pro)

Background reading: The battle for limited Global Fund resources

Visions for the future

This year’s Devex World, which took place last week in Washington, D.C., brought together leading development thinkers to hash out the future of the sector. This included several critical players from the global health arena, who sat down with us to discuss their hopes and fears:

• As the managing director of health and life sciences at Gates Ventures, Niranjan Bose has a clear view of the pipeline for global health innovations. He’s enthusiastic about the vaccines, drugs, diagnostics, and tools that could transform the health sector — such as potential new diagnostic tools for Alzheimer’s disease. Gates Ventures, a private effort that complements the work of the Gates Foundation, is working on a blood test that might make diagnosis faster and more accessible.

• John Nkengasong, the U.S. global AIDS coordinator, warned that the world is in a second battle against HIV. The first, which was marked by rampant death and suffering, ended with the widespread distribution of lifesaving treatment. But now that victory needs to be sustained, and that requires political will. He pointed specifically to the ongoing uncertainty about the reauthorization of the U.S. President’s Emergency Plan for AIDS Relief, which played a critical role in bringing the epidemic under control.

• There is always an outbreak occurring, explained the Pandemic Fund’s executive head, Priya Basu. That’s why the relatively new financing mechanism is looking at ways to become more flexible. That includes funding for specific outbreaks — like the current mpox emergency in sub-Saharan Africa — while still supporting longer-term efforts to shore up a country’s ability to detect and respond to disease.

Pro reads:

• Health innovation pipeline ‘more robust’ than ever, says Gates Ventures.

• John Nkengasong: First battle against HIV was won, but war isn't over.

• Why the Pandemic Fund is considering an emergency financing mechanism.

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Unlocking the code

It starts with a question: Why are the immune systems of a small percentage of people living with HIV able to suppress the virus without treatment? The answer to that question could unlock something much bigger in South Africa — personalized medical care that uses genetic data to tailor treatments.

To start, researchers at South Africa’s HIV Host Genome Project are looking to understand whether the genes of these “elite controllers” offer therapeutic pathways that go beyond current HIV treatment. While this would have obvious immediate benefits in a country with the highest HIV rate in the world, they believe that what they learn from this effort could also lay the groundwork for genetic research into various diseases.

There are some big challenges, though, beginning with the cost of large-scale genomic initiatives. Data privacy is also a concern. But the biggest issue in South Africa is the inequities that plague the country’s medical system, which has raised fears that personalized genomic medicine might only benefit the country’s elite.

Read: Can personalized medicine alter South Africa's fight against HIV?

Struggling to breathe

Sandstone is a sought-after material for construction. The Taj Mahal is built from it. So is the White House. But for workers across India, mining the material comes at a steep cost: The fine dust they inhale while mining sandstone can cause silicosis.

The condition produces symptoms that resemble bronchitis, including a persistent cough and difficulty breathing. In some cases, it can be deadly.

In most instances, it means that the miners are unable to work, which can severely impact their families — particularly girls. They are often forced to quit school to take on domestic tasks.

The Indian government has introduced some measures to support families affected by the disease, including schemes to help the children of miners suffering from silicosis to stay in school. But critics argue that this does little to actually prevent the disease.

Read: The disease claiming lives and childhoods in India’s mining villages

What we’re reading

Ethiopia once had malaria nearly under control. Now, the disease has returned with a vengeance, the result of a combination of conflict, climate change, and drug resistance. [The New York Times]

Often overlooked in discussions about climate change, increasing temperatures are causing more lost babies, premature births, and cognitive damage in newborns, according to a new report. [The Guardian]

The Taliban has now restricted Afghan women, already barred from speaking in public, from praying in front of one another — raising fears that they will soon no longer be allowed to speak to each other.. This could have severe health care consequences. [The Independent]

Jenny Lei Ravelo contributed to this edition of Devex CheckUp.