Tuberculosis cases surge amid the twin crises of COVID and conflict

You may have noticed that landmarks across Canada, from Niagara Falls, to the CN Tower, to the Victoria Legislature, glowed red last week. On March 24, World TB Day, these were some of the 44 landmarks across Canada that advocates ensured were lit up in red to draw attention to the fact that tuberculosis (TB), an ancient deadly disease, is surging again thanks to the twin crises of COVID-19 and conflict. TB is an airborne infectious disease that, despite being preventable and curable, claims the lives of 1.5 million people every year. It was the leading infectious killer in the world before COVID-19 and is in line to reclaim that title. TB is viewed as a proxy for inequity and injustice because it preys on those who live in poverty, are malnourished, or have weakened immune systems. That’s because in many countries, COVID-19 has disrupted or consumed health services, leading to a surge in the number of undiagnosed and untreated people living with TB. This has wiped out more than a decade of progress in the fight to end TB and resulted in the first year-on-year increase in TB deaths globally since 2005. In Canada, where TB continues to exist and disproportionately affects Indigenous peoples and newcomers, outbreaks are ongoing in several First Nation communities. This public health crisis is not only being exacerbated by COVID-19, but also by conflict and the war in Ukraine. As war forces Ukrainians to flee their homes, people living with TB will go without treatment. If people living with TB are not given the care they need, the highly contagious disease will be left to spread unchecked. People fleeing conflict are stressed and on the move. They’re not eating or sleeping well and are crowded together in unsafe environments—and they are more susceptible to disease. What’s more, Eastern Europe is the global epicentre of multi-drug resistant (MDR) TB. Despite progress in recent years, TB prevalence, mortality levels, and the incidence of MDR TB remain high in Ukraine, which has the second-highest number of cases in the region. About 32,000 people develop TB every year in Ukraine and about one-third of all cases are drug-resistant. Antibiotic-resistant TB is a growing global health security threat that demands to be taken seriously. As health systems crumble because of the war in Ukraine, mortality from HIV, TB, MDR TB, and COVID-19 will increase. Twenty-two per cent of people with TB are infected with HIV in Ukraine and TB is the leading cause of death among those living with HIV. People with TB are also more at risk of severe disease from COVID-19. We know the deadly fallout of the invasion will go beyond Ukraine; more than three million refugees have already fled for their lives. Beyond ensuring they receive the care they need, the high flow of migrants from a country with a high rate of MDR-TB demands all countries of the world pay attention. COVID-19 reminded us that infectious diseases do not respect borders. Global health solidarity is critical because no one is safe until everyone is safe. Canada has long been a leader in the global fight to end TB thanks to its support for organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and TB-specific initiatives like TB REACH—an initiative of the Stop TB Partnership that uses innovative and local approaches to find and treat people living with TB in hard-to-reach communities. Since its establishment, with sustained support from the Canadian government, TB REACH has screened more than 40 million people for TB, resulting in more than 2.6 million people being put on treatment, and 1.3 million lives saved. On World TB Day, Minister of International Development Harjit Sajjan pledged $11-million in funding to TB Reach—a welcome and critical pledge at an important time. Because of the support of Canada and TB REACH, in 2020 Ukraine became the first country in the world to provide people living with TB groundbreaking new treatments. This three-drug regimen, developed by TB Alliance, is expected to have higher success rates than previous treatments. Its introduction could finally mean replacing old and painful treatments like daily injections. Now because of the war in Ukraine, improvements that were expected from investments in the treatment of MDR-TB in Ukraine are at risk. When the minister joined partners from the global and Canadian Stop TB partnership, civil society allies, and Results Canada volunteer advocates at the Ottawa sign in the ByWard Market last week—one of the monuments lit up in red to shine a spotlight on World TB Day—he emphasized the state of urgency. “Before the pandemic, infections from tuberculosis were declining. Now, these gains are being reversed and in 2020 alone, 10 million people fell ill with TB. It is a disease we can do something about. It is a disease that can be eliminated. It is why we have been supporting efforts that have helped detecting and treating the disease successfully,” he said. “We will continue to actively support initiatives, like through the $11-million of funding to the Stop TB Partnership’s TB REACH program, who work tirelessly to find solutions that give hope to millions around the world who are fighting this terrible disease.” As we deal with the impacts of the pandemic and as the war in Ukraine continues, TB must not be forgotten. Lighting up monuments across the country demonstrates that Canadians care. They know that fighting TB means ensuring health equity, easing suffering, and building stronger health systems, equipped to respond to existing and future infectious disease threats. Chris Dendys is executive director of Results Canada and Alesia Matusevych is a board member of the TB Europe coalition. The Hill Times

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Tuberculosis cases surge amid the twin crises of COVID and conflict

COVID-19 reminded us that infectious diseases do not respect borders. Global health solidarity is critical because no one is safe until everyone is safe.

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