The year 2020 marked a watershed in global efforts to end TB by 2030. First, because by 2020 TB-affected countries aimed to achieve the first set of End TB milestones – a 35% reduction in TB deaths, a 20% reduction in TB incidence, and zero catastrophic costs for TB-affected families. And second, because throughout 2020 and into 2021, the direct and indirect impacts of the COVID-19 pandemic challenged health systems and TB programmes like never before.
Both globally and in the South-East Asia Region, TB case notifications and treatment have been disrupted. WHO data shows that several high-burden countries globally witnessed a decline of more than 50% in the number of cases reported between January and June 2020 compared with the same period the previous year.
The social and economic impact of the pandemic has been immense. Tens of millions of people have been pushed into extreme poverty. Undernutrition – a key driver of TB morbidity and mortality – has been greatly exacerbated. WHO modelling suggests that these and other gaps could result in a level of global mortality last seen in 2012, leading to an additional 1.4 million TB deaths by 2025.
Such an outcome would be catastrophic, especially in the South-East Asia Region, the world’s most TB-affected region. WHO’s recently released Global TB Report highlights that in 2020 the Region accounted for 43% of the 9.9 million patients who fell ill with TB globally. This is despite making up just over a quarter of the world’s population. The Region accounted for almost half of global TB deaths.
Amid crisis there is opportunity. The Region has in recent years mobilized unprecedented political commitment towards ending TB, which is one of eight Flagship Priorities. Ministerial-level commitments made in 2017 and 2018 have catalysed increased and much-needed investments in ending TB, in line with the Region’s Statement of Action, the UN Political Declaration on the Fight against TB, and the End TB and Sustainable Development Goal targets.
In all countries of the Region, pandemic-related disruptions have raised the stakes, highlighting the need for countries and partners to renew and reinvigorate the TB response – the focus of a high-level 26 October meeting of health ministers, policy makers and key donors from across the Region and beyond.
Several priorities require targeted attention.
First, strengthening multi-sectoral and multi-disciplinary action, for which accountability frameworks are vital. Such frameworks should define the contributions of government departments, technical and funding partners, the private sector and civil society. They must include members of TB-affected communities, ensuring patient perspectives are not only represented, but acted upon.
Second, increasing resource allocations to catch-up on lost ground. Regionally, it is estimated that up to US$ 3 billion may be required annually to achieve the End TB targets. For every dollar spent on TB, an estimated 43 dollars are returned.
Third, we must ensure access for all to rights-based, stigma-free, quality-assured and people-centred services. Such services must provide the full spectrum of care, from preventive, diagnostic and treatment care, to rehabilitative and palliative care, with a focus on reaching marginalized and vulnerable groups. If appropriately leveraged, key technologies such as artificial intelligence-based screening can not only increase efficiency, but also access and equity.
Fourth, strengthening the provision of socioeconomic support. People who are undernourished are more prone to develop TB. They have a higher likelihood of dropping out of TB treatment. TB treatment interruptions are challenging for patients and communities, increasing the likelihood of TB spread and drug resistance. To ensure all TB patients complete TB treatment, it is imperative that sensitive and accountable social protection services – including for nutrition and financial support – are not only integrated into TB programmes, but provided additional funding.
Our challenges are immense, but each can be overcome. In just a few short years, the Region has come so far in its efforts to address TB, mobilizing unprecedented investments that have achieved real progress at the grassroots and in the lives of the most vulnerable. That progress is increasingly at risk. Through urgent and synergistic action, together we must right course, ensuring all countries of the Region reinvigorate the TB response and accelerate towards the End TB targets, and a fairer, healthier, more health-secure Region for all.