by Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
On World TB Day, WHO is calling for intensified whole-of-government, whole-of-society action to end TB in the South-East Asia Region and globally, highlighting the urgent need for countries and partners to strengthen high-level leadership and investments, accelerate uptake of new WHO recommendations and innovations, better address social and economic determinants, and improve multisectoral collaboration.
Globally, the COVID-19 pandemic has not just stalled but reversed years of progress towards the End TB milestones. In 2021, the estimated burden of new and relapse TB cases globally was 10.6 million, an increase of half a million compared to 2020. Mortality from TB and TB-HIV coinfection stood at 1.6 million, an increase of around 200 000 from pre-COVID-19 levels.
The WHO South-East Asia Region bears the world’s highest TB burden. In 2021, the Region accounted for more than 45% of global TB incidence and more than half of global TB deaths. Throughout the COVID-19 response, the Region prioritised maintaining essential health services, including for TB, however in 2020 notified 2.6 million new and relapse TB cases, a 24% reduction from 2019. In 2021, the Region achieved a partial recovery, reporting 3 million new and relapsed cases, still 12% fewer than in 2019.
The COVID-19 crisis has exacerbated key social and economic determinants of TB such as poverty and undernutrition, pushing tens of millions more people in the Region into extreme poverty. Even before the pandemic, an estimated 30–80% of TB patients in the Region faced catastrophic costs due to TB, and around 1 million new TB cases annually – more than 1 in 5 – were attributable to undernutrition. It is estimated that across the Region, the overall impact of the crisis could lead to over 7 million additional TB cases and 1.5 million additional TB deaths between 2022 and 2026.
Despite immense and ongoing challenges, the Region continues to intensify action to achieve the End TB milestones, in line with its Flagship Priority and Regional Strategic Plan towards ending TB 2021–25, as well as the global End TB Strategy, the UN Political Declaration on the Fight Against TB, and Sustainable Development Goal 3.3
Preliminary data shared with WHO shows strong recovery in TB case notifications in most countries of the Region. It is anticipated that in several high-burden countries, the total number of patients initiated on treatment in 2022 will be more than in 2019, and in some cases, the highest ever. In 2022, budget allocations for TB programmes in the Region reached a cumulative total of nearly US$ 1.4 billion, almost 60% from domestic resources.
Momentum must continue to build ahead of the second UN High Level Meeting on TB, scheduled for September 2023, which will bring together Heads of State from across the world to mobilize increased political and social commitment to end TB, ensuring comprehensive and universal care for all.
For that, the Region has several priorities. First, strengthening high-level leadership, engagement and advocacy to increase investments to end TB. WHO estimates that the Region needs at least US$ 3 billion annually to avert nearly 4.5 million new TB cases and prevent more than 1.5 million TB deaths by 2025. Countries and partners must urgently – and sustainably – increase funding availability and strengthen investments, recognizing that for every dollar invested, 40 are returned.
Second, accelerating uptake of new WHO recommendations and innovations. To date, more than 5000 molecular test platforms have been deployed across the Region to rapidly detect TB and drug resistance. Such platforms must continue to be scaled to ensure prompt diagnosis and treatment, and to reduce spread. In all countries, a new WHO-approved treatment regimen that has shown better cure rates in just 6–9 months should be rapidly adopted and rolled out.
Third, adequately – and aggressively – addressing the social and economic determinants of TB, which are a major, ongoing challenge. For this, mechanisms should be established and/or strengthened to support TB patients and their families to avoid catastrophic costs, supplement nutrition and promote treatment adherence. Stigma and discrimination must continue to be tackled, including through community engagement and empowerment initiatives that promote high-quality information, and which include affected communities in all aspects of policy and programme design, planning and monitoring.
Fourth, improving multisectoral collaboration. The health sector alone cannot end TB. Rather, ending TB requires dedicated action from multiple sectors, which as highlighted at the 2021 Regional High-level Meeting to End TB, should be coordinated by national high-level mechanisms. Such mechanisms – which seven countries have developed – must define clear roles and responsibilities, and should be accompanied by an accountability framework that is aligned with WHO guidance.
Together, we can end TB. But let us be candid: achieving that outcome will be a massive challenge, requiring unprecedented whole-of-government, whole-of-society action. On World TB Day, WHO reiterates its commitment to support all countries of the Region to get back on track, to turn the tide, and to end TB by 2030, leaving no one behind.