Significant progress has been made to reduce the global burden of tuberculosis (TB) since the discovery of the tubercle bacillus, by Dr Robert Kock on 24 March 1882, the date we have come to know as World TB Day. Increased political will has contributed to the development of new diagnostic tools and treatments which have reduced the morbidity and mortality associated with the disease, providing hope that global targets to end TB by 2030 can be achieved.
Although progress towards TB has been substantial, sadly, it has not been equitable, and the burden of TB continues to affect communities that lack the resources for adequate prevention, treatment and care. As a result, TB remains a significant health burden in 30 low- and middle-income countries across the WHO African and South-East Asian Regions and is often associated with, and exacerbated by, other existing health challenges, including HIV.
The limited resources available to health systems in high-burden areas are adding additional challenges to global efforts to eliminate TB. Most notably, improper administration in use of first line TB drugs (isoniazid and rifampin) is contributing to increasing rates of drug resistant TB infections that require second-line treatments. This has resulted in a significantly lower cure rate (50% vs 95–97%) and imposes an additional burden on already strained health systems.
In order to accelerate and sustain progress towards the World Health Organization End TB targets, there is an urgent need to equalise the standard of care provided by the public and private sectors by engaging all care providers under the same national TB program standards. This includes enabling rapid diagnostics, such as rapid molecular tests (including GeneXpert) and screening along with sputum culture to test for drug resistance. Household contact tracing and community referral is another cost-effective method of timely diagnosis that can reduce treatment seeking delay and provide accurate information to the general public on TB care. In addition to active TB management interventions, practicing efficient preventative therapy will be critical to reduce disease progression and spread.
In 2016, a cost-effectiveness study of TB strategies in China, India and South Africa, published in The Lancet Global Health, concluded that the expansion of TB services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions from a societal perspective. Despite this, a substantial funding gap in many high burden countries represents a major challenge for health systems to sufficiently deliver TB services. Notably, in 2020, global funding for TB prevention, diagnosis, treatment and care reached US$ 6.5 billion, representing only half of the US$13 billion target agreed by world leaders in the UN Political Declaration on TB. For progress to continue, renewed commitment and investment is urgently needed to support countries most affected by TB.
Tuberculosis has deep roots throughout human history. It dates back to at least 4000BC and has been a major cause of morbidity and mortality across high- and low-income settings alike. The progress made to reduce TB across many high-income settings demonstrates what can be achieved with sustained investments across the spectrum of prevention, treatment and care when it is integrated equitably into health systems. However, as the World TB Day 2021 theme suggests, ‘The Clock is Ticking’, and no country should be complacent as the rise of drug resistant TB means that TB anywhere, could result in the rise of TB everywhere.
Investment in the global elimination of TB will have an immediate and profound benefit for many of the world’s most vulnerable communities, while also strengthening the resilience of health systems, increasing global health security and advancing progress towards universal health coverage. That is why, this World TB Day, we are joining global partners to call for accelerated action worldwide to deliver equitable access to quality and timely diagnosis, prevention, treatment and care, with no one left behind.
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