Is tuberculosis being left out of climate-health debate?

There’s increasing recognition of the impact of climate change on health. But one ancient disease is missing from the picture: tuberculosis. Unlike diseases such as malaria and dengue, the links between climate change and TB aren’t as direct. But the impact of climate change on issues such as displacement and malnutrition can have serious consequences for TB, according to experts. “It's not global climate change that will impact directly tuberculosis. However, it will be the cause for a number of changes that will indirectly worsen the situation of tuberculosis,” Dr. Maria Beumont, vice president, chief medical officer for research and development at the TB Alliance, told Devex. The frequency and severity of natural disasters happening due to climate change can cause massive displacements, interrupting people’s access to care. That does not bode well for the management of patients with TB who need to be taking their treatments daily and without interruption. But it also could affect the management of diseases, such as HIV and AIDS and diabetes, which are known to weaken a person’s immune system, increasing their risk to develop active TB disease. Displacement also puts patients in a vulnerable position that could make access to care difficult. Being placed in crowded areas, without being diagnosed or treated, also allows TB to spread. Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, alluded to the impact climate-driven displacement will have on TB spread in a WHO event on Wednesday, in the lead-up to World TB Day. He said the world is going to see large numbers of displaced people and refugees fleeing their homes because they are desertified, or “just too hot to be in.” Conflict over resources, such as water, will also drive displacement. “And we all know that TB likes nothing more than highly stressed populations, living away from home, in tents or other sorts of impromptu accommodation and highly crowded circumstances,” he said, calling for the TB community to start thinking about current TB programs and how it can accommodate these large numbers of displaced people. “Because then it’s going to come at us. And it’s going to come at us, sadly, pretty fast. I mean it’s with us already,” he said. But it’s not just displacement. The ability of people to access food also has implications for TB. Droughts — which the IPCC report projects will become more frequent with a further warming of the planet — have an impact on food security, with lower crop yields and livestock dying because of reduced food and water sources. This can affect people’s nutrition, making people susceptible to TB infection. Some studies are already making these connections, but TB is mostly absent in climate change and health discussions. “We try to be very vocal about it. We do include it in our presentations as one of the things that we need to try to be one step ahead,” Beumont said. One way they’re doing that is by finding and developing shorter, faster-acting treatment regimens for TB, such as BPaL, a six-month, all-oral regimen for drug-resistant TB comprising the drugs bedaquiline, pretomanid, and linezolid that’s shorter and that WHO recommended last year. TB Alliance developed the drug pretomanid. WHO and its partners issued a call to action this week calling on governments and others to accelerate the implementation of this new treatment regimen. Beumont said the regimen allowed people living with drug-resistant TB in Ukraine to continue with their treatment even after being displaced amid the war. The displacement in Ukraine is not due to climate change per se, but it shows how such a treatment can be useful for climate-driven displacement. “This is, I would say, probably a way to imagine what could happen if you have tuberculosis, you are displaced, how useful it would be to have a treatment that you can carry on with you,” she said. Getting policymakers to recognize these linkages is critical, given the increasing recognition of the impact of climate change on health and the attention climate change is getting from funding agencies. Advocates have been calling for more investments in TB, including for TB research and development to fund new vaccines, treatments, and diagnostics. In 2022, the Stop TB Partnership launched an ambitious plan, requiring $250 billion, to end TB by 2030. The investment will also help strengthen health systems and improve countries’ capacities to respond to other airborne infections. But TB is a chronically underfunded disease. And funding for TB research and development remains below the $2 billion per year amount governments committed to at the U.N. high-level meeting on TB in 2018. Some fear climate change could further reduce resources for TB. “We are trying to fight those disturbances by really focusing our efforts to find very short treatments that could be effective to treat all kinds and forms of tuberculosis. But of course … different efforts from other groups will be necessary,” Beumont said. Visit the Talking TB series for more coverage on how we can eliminate tuberculosis by 2030. The time for a paradigm shift and a renewed focus on funding, research, and global solutions is now. Join the conversation by using the hashtag #TalkingTB.