Opinion: No more excuses — we can end TB in children

Every year, 1.2 million children develop tuberculosis — an airborne, deadly disease that has been around for centuries. Even worse, more than half of these children are never diagnosed, much less treated, and 18% do not survive. 

That is one way TB is slowly regaining its infamous title as the world’s leading infectious disease killer, toppling the COVID-19 virus from the top of the charts.

Within a year of the COVID-19 virus ravaging the globe, we saw how governments, health practitioners, scientists, foundations, and NGOs came together to develop and distribute vaccines that slowed the spread of the virus and saved lives. The effort was unprecedented — and stands in stark contrast to the world’s approach to the prevention and treatment of TB.

Failing children

Despite it being preventable, treatable, and curable, TB remains one of the most serious infectious diseases affecting children. According to the World Health Organization’s Global TB report, in 2022 there were an estimated 214,000 deaths in children under 15 years due to TB.

It gets worse. At the 2018 United Nations High-Level Meeting on TB, countries' heads of state and governments committed to treating 3.5 million children with TB by 2022. By the end of 2021, only 54% of that target had been met. Part of that pledge was to treat 115,000 children specifically suffering from drug-resistant forms of TB, known as DR-TB, but again, by the end of 2021, only 15% of them had received treatment. It is safe to say that these targets will not be met. We are failing our children.

Why is this so difficult? The answer lies in the steps taken to prevent, detect and treat TB.

July 2021 marked a century since the bacille Calmette-Guérin vaccine against TB was given to children for the first time, to help prevent them from developing TB.

To this day, it remains the only TB vaccine that has been approved and licensed in the world. Billions of children across the globe have received it, but it reliably protects against severe forms of TB in only very young children.

Diagnosis gaps  

There are close to 600 TB-related deaths in children every single day.  We can end TB in children, but we need a vaccine urgently that is more effective in protecting children of all age groups.

The key issue that needs to be addressed for children with TB and DR-TB, is that too few are being diagnosed and enrolled in treatment. It starts with a lack of contact screening, TB infection testing, and preventive treatment.

Health care workers on the front lines, too often do not have the knowledge or tools to suspect and diagnose TB in children. Many children who show up at clinics or hospitals with non-specific symptoms — such as fever, cough, or weakness in the body — and go undiagnosed and untreated. More children still simply do not have access to a health care worker or a health unit equipped and able to diagnose TB in the first place.      

Often, social factors contribute to creating barriers to children reaching treatment such as coming from families or parents affected by stigma, poverty, and other vulnerabilities, all contribute to the high numbers of children with TB.    

These are all barriers to care that can and should be addressed, especially among children. It is clear that more resources need to be poured into community-centered TB interventions, but here too, the international community has fallen short.

At the U.N. High-Level Meeting in 2018, governments pledged to drastically increase spending on TB prevention, detection, treatment, and research. Instead, the amount provided in 2021 was less than half of what was pledged.

COVID-19 provided an excuse for not reaching the targets — we won't know what might have happened without that unprecedented event. What we do know is that despite the ongoing threat and rising rates of TB, it is still not treated as a priority.

Hope for the future

There is however hope. Just in the last decade, progress has been made in the development of TB drugs and regimens for both children and adults. The WHO recently released updates to the guidance for child and adolescent TB along with an operational handbook.    

The guidance has several important updates including shorter regimens for children with non-severe TB, and TB meningitis, and has extended the use of all-oral, injectable free, shorter drug resistant regimens for children of all ages. Shorter regimens usually lead to better drug acceptability, treatment completion rates and a better quality of life for children and their caregivers.

Stop TB Partnership’s Global Drug Facility led the introduction of child-friendly formulations of DR-TB medicines.

All 11 medicines to treat DR-TB in children are now available as child-friendly, dispersible formulations — this was unimaginable just a few years ago.    

And while TB programs have responded by buying drugs to treat children from the facility, the effort so far falls short of reaching the number of children that continue to need to be diagnosed and treated for DR-TB.

Accelerating action

It is time to scale up these efforts and ensure that all children have access to new diagnostics and treatment regimens for TB.

We can end TB if we want to. It took less than two years to develop several tools to fight COVID-19, including point-of-care diagnosis, treatments, and vaccines because the world came together to fight it.

But it has been over a century since the only partially functioning TB vaccine was first approved for use.

It is an outrage that TB prevention, detection, and treatment has yet to be prioritized despite the large number of children it sickens and kills. For the sake of children all over the world, we need to change this now. Yes! We can!

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.