The clock is ticking on global efforts to end the tuberculosis (TB) epidemic, which kills an estimated 4000 people every day and has for many years been the world’s leading cause of death from a single infectious agent. In 2019 an estimated 10 million people globally fell ill with TB and around 1.4 million people died from the disease, almost 15% of whom were coinfected with HIV. Close to half a million people developed multi-drug or rifampicin-resistant TB, a public health crisis and health security threat. Despite comprising around 26% of the world’s population, the WHO South-East Asia Region accounts for 44% of global TB incidence and almost half of global TB deaths. Since 2017, accelerating efforts to end TB by 2030 has been one of the Region’s eight Flagship Priorities, which WHO and its Member States have continued to pursue amid the COVID-19 response.
Progress against TB has in recent years been strong. Since 2015 the Region has increased treatment coverage by more than 30% and raised case notification from 2.6 million to 3.6 million. Most countries have substantially scaled up TB funding, with some countries tripling it. All countries are committed to achieving the targets identified in the UN Political Declaration on the Fight against TB and continue to implement the WHO End TB Strategy. The 2020 WHO Global TB Report highlights how Bangladesh, Myanmar and Thailand are on track to achieve the first End TB milestone on reducing TB mortality by 35%, while Myanmar is also on track to have reduced the TB incidence rate by at least 20%. Commendably, India last year launched a “Jan Andolan”, or people’s movement, against TB, while Indonesia began implementing its Presidential Initiative on TB, which aims to accelerate action to end the disease, with a focus on scaling up domestic resource allocations.
Throughout the COVID-19 response, WHO and its Member States in the Region have made concerted and largely successful efforts to maintain essential health services, including for TB and other infectious diseases. Though a WHO modelling study released in May 2020 suggested that gaps in TB diagnosis and treatment caused by the COVID-19 outbreak could result in a level of global mortality last seen in 2012, this worst-case outcome has almost certainly been averted, due in large part to the quick thinking and rapid action of TB programme staff from across the Region. Preliminary data suggests an average decrease in TB case notification in the Region in 2020 of around 20–25%, equating to around 1 million missing cases. To find and treat these cases and accelerate towards the End TB milestones, WHO will continue to support all countries in the Region to intensify action that is comprehensive and people-centred, with a focus on several priority areas of work.
First, creating or enabling multisectoral mechanisms that are empowered through high-level political buy-in. Such mechanisms will help stakeholders plan and implement coherent multisectoral action and establish clear lines of accountability. Second, promoting meaningful community engagement through capacity building and partnering at all levels of programme planning, monitoring and implementation. Community health workers, youth and civil society hold immense potential to help intensify case finding and enhance access to TB preventive treatment. Third, addressing the social and economic determinants of TB. Opportunities to streamline patient and nutrition support schemes should be identified and grasped. Poverty reduction strategies must continue to be rolled out. And fourth, exploring innovative ways to cut costs and expand funding sources. Integrated action across disease programmes will amplify impact in resource-constrained settings. Collaboration among countries could help lower the price of drugs. The front-loading of resources from international and global partners would prove particularly valuable, helping to close the Region’s annual TB funding gap of close to US$ 1 billion.
Not a second can be spared. Every day, nearly 4000 people globally lose their life to what is a preventable and, in most cases, treatable disease. That is 4000 too many. Though the COVID-19 crisis continues to provide immense challenges for health systems and TB programmes in the Region and across the world, we must prevent the possibility of a sustained lapse. We can – and must – prevail. Amid the ongoing COVID-19 response, recovery and beyond, together we must catch up and reclaim the advantage against TB, and accelerate towards the Region’s Flagship Priorities, the End TB milestones, and a healthier and more sustainable world for all.