Opinion: COVID-19 diverted lifesaving tuberculosis work. But there is still hope.

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A tuberculosis patient receives TB medication. Photo by: USAID Central Asia / CC BY-ND

In 2020, we all witnessed, in real time, the deadly impact of an airborne pandemic. In just over a year, more than 2.7 million people have died from COVID-19. But in the lowest-income and most marginalized communities around the world, another airborne disease — tuberculosis — has been killing tens of millions of people for millennia. And with the arrival of COVID-19, it’s getting worse.

As COVID-19 spread around the world, health workers, testing machines, laboratories, and health centers were diverted from existing diseases like TB to fight the new pandemic. Preliminary data from surveys by the Global Fund to Fight AIDS, Tuberculosis and Malaria reveals the deadly impact of these diverted resources.

In 13 high-burden TB countries, 29% fewer people were tested for TB in 2020, compared with 2019. Without treatment, a single person with TB can infect up to 15 others over the course of a year, or they may die. Worse, in those same countries, there were 45% fewer people tested for multidrug-resistant TB — one of the most frightening forms of antimicrobial resistance.

But there is hope. The COVID-19 pandemic has sparked unprecedented collaboration, showing that global partners can act together to innovate and move with speed and scale to solve a major threat to health security. Together with South Africa, Norway co-chairs the Facilitation Council for the Access to COVID-19 Tools Accelerator, the global coalition to ensure equitable access to COVID-19 tests, treatments, and vaccines. The Global Fund is a founding partner of the ACT-Accelerator.

After the pandemic hit, the Global Fund, with a generous contribution from Norway, provided nearly $1 billion to help mitigate the impact of COVID-19 on HIV, TB, and malaria programs, as well as to reinforce health systems.

With the right leadership and funding, it is possible to protect progress in the fight against TB at the same time as fighting COVID-19 — and to be better prepared for future airborne pandemics.

While it is still early days, it appears that adaptation efforts are working and must be scaled up. For example, while TB testing levels plummeted in India and Bangladesh in the first months after the pandemic hit, the countries also implemented adaptation measures. By the end of 2020, they were testing and treating nearly the same number of TB patients as they were before COVID-19.

COVID-19 has also challenged us to accelerate new approaches to fighting TB. To reduce the need for travel, TB patients are now provided with one to two months of TB drugs, and countries have been encouraged to rapidly transition to all-oral treatment regimens for drug-resistant TB. Instead of resource-intensive, daily check-ins at a health clinic, new smartphone applications enable patients to report progress virtually. This increases adherence to treatment and enables us to reach more people with TB and to accelerate the end of the epidemic.

With the right leadership and funding, it is possible to protect progress in the fight against TB at the same time as fighting COVID-19 — and to be better prepared for future airborne pandemics.

The same tools the Global Fund partnership has built to fight TB are now being used to fight COVID-19. Community health workers test, trace, and isolate to prevent onward transmission. Community groups share critical prevention information to protect people from infection, and labs and health centers are already equipped with the machines and training needed to test for both diseases.

Again, India leads the way, with a new program that tests people for COVID-19 and TB at the same time. As they have similar symptoms, this simple step can stop onward transmission of both diseases — and ensure that TB patients are treated and cured.

Perhaps more importantly, COVID-19 also shows us what’s possible when the world is united against a common enemy and provides the resources to fight it. Rapid tests and vaccines for COVID-19 were developed in less than a year, and real-time data on the COVID-19 pandemic enables countries to quickly respond to and contain outbreaks. By comparison, TB still lacks an effective vaccine; tests are costly and must be done in a lab; and instead of daily data reports, the global TB community must wait 18 months before yearly statistics are shared.

If we can do this for COVID-19, we can and must do the same for TB. If we don’t, we run the risk of defeating one airborne disease only to watch deaths and cases soar from another.

Opinion: To recover from COVID-19, donor support for tuberculosis must increase

Unlike for COVID-19, generating the political will to end TB has long been a struggle. Here are some steps donor governments must take to bring work back on track for ending the disease.

Even before COVID-19 hit, more than 1.4 million people died of TB every year. And out of the 10 million people who fell ill with TB in 2019, only 7.1 million were tested and treated — which leaves 2.9 million “missing” people with TB who can continue to pass the disease to others, or die, without treatment. The fewer people we find, test, and treat, the more TB cases there will be and the higher the risk of multidrug-resistant TB spreading worldwide.

This World TB Day, we must learn from our experience fighting TB and COVID-19. We must reinforce the world’s health systems and unite our resources to fight both diseases and to prepare for the future airborne pandemics we know will come. No one is safe until everyone is safe.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the authors

  • Peter Sands

    Peter Sands became executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria in March 2018. A passionate advocate for global health, Sands leads work at the Global Fund to end epidemics and build stronger health systems. Sands served as chief executive of Standard Chartered Bank from 2006 to 2015, and in recent years has immersed himself in global health issues. He supports more international and domestic investments for greater global health security, and he often highlights the economic impact of infectious diseases.
  • Dag-Inge Ulstein

    Dag Inge Ulstein, minister of international development in Norway, is co-chair of the Facilitation Council for the Access to Covid-19 Tools Accelerator, the World Health Organization-led global collaboration to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines.