COVID-19 derails global quest to end tuberculosis

The health inequities made clear by COVID-19—like the hoarding and accompanied famine of vaccines between wealthy and low-income countries—reinforce a fact that those working and living with neglected diseases like tuberculosis have long known to be true: power relations dictate whose lives are worth saving and whose are not. Before COVID-19, tuberculosis (TB) was the deadliest infectious disease in the world, killing 1.4 million people in 2019 alone. The disease has existed for millennia yet has never garnered the global response, political will, or financial resources that the world has produced for the COVID-19 pandemic. Although this phenomenon is unsettling, it is not particularly difficult to understand. TB predominately affects people living in poverty, and diseases linked to poverty have a reputation for being neglected by global leaders. Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, argues that even the language used to describe the “epidemics” of AIDS, TB, and malaria diminishes the scale of the burden of these diseases because of the populations they tend to affect most. Despite TB being, by definition, a “pandemic,” we often do not call it that. He stated that the use of the word "epidemics" instead of "pandemics" is not just about semantics, but rather about who we care lives or dies. Leigh Raithby is a policy and advocacy officer at Results Canada, a non-profit organization on a mission to generate the political will to end extreme poverty. Photograph courtesy of Results Canada Tuberculosis is present in every region of the world, but disproportionately affects populations facing systemic barriers to achieving good health. TB is strongly linked to the social determinants of health and is fueled by factors such as malnutrition, inadequate housing, and poor access to care. Even in wealthy nations like Canada, TB continues to exist among Indigenous and newcomer communities, with the incidence of TB among Canada’s Inuit population being 290 times higher than the non-Indigenous Canadian-born population. The continued existence of TB demonstrates the health inequities that persist around the world, including in Canada. In addition to the systemic barriers and cycles of poverty that allow TB to thrive among marginalized communities, there are financial barriers to ending this ancient disease. TB has long been underfunded and under resourced, with less than half of the global financial target needed to fight TB met in recent years. This lack of funding seriously impedes our ability to address TB, as the tools we have at our disposal are outdated and insufficient. The only vaccine against TB is 100-years old; and current treatment against TB takes months or even years to complete. In addition the treatment is complicated, and toxic. These medical limitations, coupled with physical and social barriers to accessing care, prevent people affected by TB from getting the care they need. Where and how someone lives should not dictate if they live. And yet it does. Active TB is a preventable and curable disease that continues to affect some 10 million people every year. Someone with active TB will become ill and infectious, compared to someone with latent TB infection who may not have symptoms nor be contagious. In total, about one quarter of the world's population is latently infected with the bacterium Mycobacterium tuberculosis, which causes TB. Although a small percentage of these people will develop active tuberculosis disease, there is increasing concern about the impact that COVID-19 has had on TB services and what this may mean for the incidence of both latent and active TB. With tuberculosis services being disrupted for the past two years, we know that people with TB are being missed, left undiagnosed, and untreated. This disruption to service provision has resulted in the first year-on-year increase in TB deaths since 2005. Health-care workers in Canada have likewise reported that COVID-19 disruptions have resulted in diagnostic delays, individuals presenting with more advanced disease, large-scale diversions of TB staff to COVID-19 work, and declines in quality of TB care. These findings echo the global consensus that we are moving backwards in the fight against TB. Neglect in addressing diseases linked to poverty like TB has gone on for far too long. We cannot continue to leave behind people affected by TB at a time when they need solutions more than ever. On March 24, World TB Day, advocates around the world are calling on global leaders to follow through on their commitments to TB elimination, as outlined in the Sustainable Development Goal 3 target of ending TB by 2030. Nearly 40 monuments across Canada will be lit up in red on March 24 to commemorate World TB Day and remind our leaders of their global and domestic commitments to ending TB. COVID-19 has set us off track in the quest to end TB. We are at a critical point in history, where leaders can either step up for those affected by TB or accept that their inaction will cause needless suffering and millions of avoidable deaths. Leigh Raithby is a policy and advocacy officer at Results Canada, a non-profit organization on a mission to generate the political will to end extreme poverty. Raithby is also part of the secretariat of Stop TB Canada, a network of Canadians committed to ending tuberculosis at home and abroad. The Hill Times

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COVID-19 derails global quest to end tuberculosis

Tuberculosis has existed for millennia yet has never garnered the global response, political will, or financial resources that the world has produced for the COVID-19 pandemic.

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