The resurgence of ‘ticking timebomb’ tuberculosis

Tuberculosis is set to overtake Covid-19 as the world’s most deadly infectious disease, with medical experts warning its resurgence represents a “ticking timebomb” healthcare emergency.

An infectious disease caused by a bacteria called Mycobacterium tuberculosis that affects the lungs, TB – then known as consumption – caused 25% of all deaths in Europe between 1600 and 1800.

It still kills roughly 4,400 people around the world every day, or one person every 20 seconds, according to the Stop TB Partnership. “Its incidence varies significantly across regions,” said Shyam Bishen, head of the Centre for Health and Healthcare at the World Economic Forum, with eight countries accounting for more than two-thirds of the global total of cases: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of Congo.

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“There are clearly social determinants to tuberculosis – it’s the disease of the world’s poor,” said Bishen. And after two decades in decline, TB rates are on the rise again.

Why are rates rising?

“The TB epidemic is driven by a host of factors, including poverty, malnutrition and HIV, and disproportionately affects the most vulnerable in all countries,” said Al Jazeera, but the resurgence of the disease has been attributed primarily to the impact of the Covid-19 pandemic.

An estimated 10.6 million people contracted TB in 2021 – a 4.5% increase on 2020, the World Health Organization (WHO) said in its annual Global TB report. It concluded that Covid “continues to have a damaging impact on access to TB diagnosis and treatment and the burden of TB disease. Progress made in the years up to 2019 has slowed, stalled or reversed, and global TB targets are off track. Intensified efforts backed by increased funding are urgently required to mitigate and reverse the negative impacts of the pandemic on TB.”

Spending on TB services worldwide, for example, fell from $6 billion in 2019 to $5.4 billion in 2021 as diagnosis and treatment resources were diverted towards managing the pandemic.

Le Monde said that “conflicts around the world, the global energy crisis and associated risks to food security were likely to worsen the situation further”.

Dr Lucica Ditiu, executive director of the Stop TB Partnership, highlighted two flashpoints: the war in Ukraine, which has the highest number of people estimated to have TB in Europe at 34,000, and conflict in Sudan, where ongoing fighting and the collapse of most of the health system is “probably like a ticking bomb”.

The perfect storm of Covid and conflict has prompted Tereza Kasaeva, the director of the UN health agency’s global TB programme, to claim now is a “pivotal moment” in the fight against the disease, said Le Monde.

What is being done to stop it?

TB kills, said Bishen of the World Economic Forum, “but it’s an entirely curable and preventable disease that requires more funding”.

The Washington Post noted that from the 1940s to 1960s, eight separate classes of anti-TB drugs were synthesised to fight the disease, “but then no new drugs were developed to fight TB until 2012.

“As tuberculosis became less of a problem in rich countries with robust health-care systems, the profit incentives changed, making TB less of a priority for pharmaceutical companies even as it continued to be a huge problem for humanity,” the paper said.

Addressing a meeting of UN health leaders in New York this week, UN Deputy Secretary-General Amina Mohammed said $22 billion was needed to provide all people diagnosed with TB access to quality treatment by 2027 along with access to health and social benefits so they do not suffer financial hardship. An additional $5bn a year is needed for research and innovation.

Is there a vaccine?

The problem, said the Daily Mirror, is that “we still have no vaccine that works in adults”. The BCG jab given to children was first administered more than 100 years ago and, while still the most widely used vaccine in the world, immunity does not last to teenage years and no booster has yet been developed.

There are currently 16 TB vaccines in research and development stage but “because of a lack of funds, it has taken 19 years to get three or four vaccines for TB to phase three trials, whereas the Covid vaccine was developed in a year”, said Al Jazeera. This is despite a recent study suggesting that every $1 invested in the 50% effective vaccines could return $7 through saved healthcare costs and increased productivity.

At the same time, “TB is developing greater resistance to the handful of antibiotics able to treat it because many patients in impoverished communities are unable to continue with the drugs for the minimum six months required to clear disease”, said the Mirror. “This means it comes back stronger and treating these superstrains can take two years. Almost a third of such patients do not survive. Therefore it is vital to develop quicker treatments that kill off the disease before more mutant strains develop and spread.”

Hope may lie in a trial currently underway in South Africa. The largest clinical trial of TB treatments in history is a combined effort involving research institutions in the UK, US, India, Vietnam, Indonesia, Madagascar and the Ivory Coast with the ultimate aim to find a “one-shot” cure, said the Mirror.