Reinvigorate efforts to end TB

The year 2020 marked a watershed in global efforts to end tuberculosis (TB) by 2030. First, it was because, by 2020, the TB-affected countries aimed to achieve the first set of "End TB" milestones: a 35 percent reduction in TB deaths, a 20 percent reduction in TB incidence, and zero catastrophic costs for TB-affected families. And second, it was because throughout 2020 and into 2021, the direct and indirect impacts of the Covid-19 pandemic challenged healthcare systems and TB programmes like never before.

Both globally and in the Southeast Asia region, TB case notifications and treatment have been disrupted. Data from World Health Organization (WHO) shows that several high-burden countries globally witnessed a decline of more than 50 percent in the number of cases reported between January and June 2020, compared with the same period the previous year.

The social and economic impacts of the pandemic have been immense. Tens of millions of people have been pushed into extreme poverty. Undernutrition—a key driver of TB morbidity and mortality—has been greatly exacerbated. WHO modelling suggests that these and other gaps could result in a level of global mortality last seen in 2012, leading to an additional 1.4 million TB deaths by 2025.

Such an outcome would be catastrophic, especially in the Southeast Asia Region, which is the world's most TB-affected region. WHO's recently released Global Tuberculosis Report highlights that in 2020, the region accounted for 43 percent of the 9.9 million patients who fell ill with TB globally. This is despite making up just over a quarter of the world's population. The region accounted for almost half of global TB deaths.

However, amid crisis there is opportunity. The region has in recent years mobilised unprecedented political commitment towards ending TB, which is one of the eight Flagship Priorities. Ministerial-level commitments made in 2017 and 2018 have catalysed increased and much-needed investments in ending TB, in line with the region's Statement of Action, the UN Political Declaration on the Fight against TB, and the End TB and Sustainable Development Goal (SDG) targets.

In all countries of the Southeast Asia region, pandemic-related disruptions have raised the stakes, highlighting the need for countries and partners to renew and reinvigorate the TB response—the focus of a high-level meeting of health ministers, policymakers and key donors from across the region and beyond, scheduled for October 26.

Several priorities require targeted attention. First is strengthening multi-sectoral and multi-disciplinary action, for which accountability frameworks are vital. Such frameworks should define the contributions of government departments, technical and funding partners, the private sector, and civil society. They must include members of TB-affected communities, ensuring that patient perspectives are not only represented, but acted upon.

The second issue that needs attention is increasing resource allocations to catch up on lost ground. Regionally, it is estimated that up to USD 3 billion may be required annually to achieve the End TB targets. For every dollar spent on TB, an estimated 43 dollars are returned.

Third, we must ensure access for all to rights-based, stigma-free, quality-assured, and people-centred services. Such services must provide the full spectrum of care—from preventive, diagnostic and treatment care, to rehabilitative and palliative care–with a focus on reaching marginalised and vulnerable groups. If appropriately leveraged, key technologies such as artificial intelligence-based screening can not only increase efficiency, but also access and equity.

Fourth, strengthening the provision of socioeconomic support. People who are undernourished are more prone to develop TB. They have a higher likelihood of dropping out of TB treatment. TB treatment interruptions are challenging for patients and communities, increasing the likelihood of TB spread and drug resistance. To ensure that all TB patients complete TB treatment, it is imperative that sensitive and accountable social protection services—including nutrition and financial support—are not only integrated into TB programmes, but provided additional funding.

Our challenges are immense, but each of them can be overcome. In just a few short years, the Southeast Asia region has come so far in its efforts to address TB, mobilising unprecedented investments that have achieved real progress at the grassroots and in the lives of the most vulnerable. That progress is increasingly at risk. Through urgent and synergistic action, together we must right the course, ensuring that all countries of the region reinvigorate the TB response and accelerate towards the End TB targets, and achieve a fairer, healthier, more health-secure region.

Dr Poonam Khetrapal Singh is regional director in South-East Asia at World Health Organization (WHO).