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

Like COVID-19, tuberculosis is an airborne respiratory infection. Before the start of the pandemic, TB was the leading infectious disease killer in the world. In 2019, about 10 million people fell sick with the disease and an estimated 1.4 million died of it.

COVID-19 has caused a massive setback for TB. The pandemic response compromised TB services, resulting in a 20% drop in diagnosis and treatment worldwide, according to the Stop TB Partnership. Poor TB care also means more people are dying. The World Health Organization estimates that an additional 400,000 people could have died of TB in 2020.

Similarities in controlling the spread of both diseases has meant that diversion from TB resources has been vast during the pandemic. For example, GeneXpert diagnostic machines normally used for TB have been repurposed for COVID-19 testing. TB wards have been converted into COVID-19 wards. People and organizations long engaged in the fight to end TB have been called upon to fight COVID-19.

Unlike the incredible collaboration, innovation, and investment we have seen to end COVID-19, generating the political will to end TB has long been a struggle. There is a major and deadly divide between the commitments governments have made to end TB and the reality of what is being delivered on the ground.

Even before the pandemic, the world was not on track to meet elimination targets that governments agreed to at the United Nations’ high-level meeting on TB in 2018 or the Sustainable Development Goal to end the epidemic by 2030. Now, over the course of just 12 months, progress in the fight against TB has been set back by 12 years.

Ultimately, there is an incredible amount of catch-up work to get back on track for ending TB — and the urgency for doing so is very real. Most often, people affected by TB live in marginalized communities. With COVID-19 resulting in the first significant increase in global poverty in over 20 years, more people will be at risk of infection. Additionally, immunocompromised people with TB are at serious risk of complications, should they get COVID-19. Drug-resistant forms of TB also present a serious threat to global health security.

Failure to take unprecedented action to propel efforts for ending TB would be a missed opportunity with devastating consequences.

The pandemic, meanwhile, presents an incredible opportunity for donors to make an outside impact toward ending TB. With smart investments, we could translate momentum around the COVID-19 response into valuable solutions for TB and future pandemic preparedness.

All donors should scale up investments this year to close TB funding gaps and lead in both COVID-19 recovery and TB elimination work. A global total of $13 billion needs to be invested annually by 2022 for TB funding to be considered sufficient and sustainable. Yet in 2020, total spending was only half of that.

As the leading investor in TB, the United States has a particularly important role to play — hence our sector's relief to see that it is back on the global health and diplomacy stage. We applaud the U.S. government’s recent announcement to invest $3.5 billion into the Global Fund to Fight AIDS, Tuberculosis and Malaria’s emergency response to COVID-19. We call on the government to also increase TB investments via the U.S. Agency for International Development, as well as the National Institutes of Health and Centers for Disease Control and Prevention.

We are disappointed to see the United Kingdom’s recent aid budget cuts, since it is also a major contributor to global TB control. All donors, including philanthropies, should be stepping up — not retrenching.

Canada has a particularly unique opportunity to demonstrate leadership in mitigating the pandemic’s devastating ripple effects. The country must deliver on its pledge to eliminate TB among Inuit in Inuit Nunangat by 2030.

Canada must also continue to invest in global TB elimination. TB REACH, which was founded in 2010 with funding from the country, works to find people with TB in hard-to-reach communities. Canada’s funding for TB REACH sunsets this month and should be maintained, if not increased. Otherwise, millions more people with TB will be left behind.

People affected by TB cannot wait any longer for donors to keep their promises to end the epidemic. The world moved figurative mountains to respond to COVID-19 and churned out multiple COVID-19 vaccines in less than a year. We now know what is possible, yet we still only have one century-old vaccine for TB. We can and must do better to end TB.