The World Health Organization (WHO) has recently released the Global TB Report 2021.
In 2014 and 2015, all Member States of WHO and the UN adopted the UN Sustainable Development Goals (SDGs) and WHO’s End TB Strategy. The SDGs and End TB Strategy both include targets and milestones for large reductions in TB incidence, TB deaths and costs faced by TB patients and their households.
The WHO End TB Strategy aims for a 90 per cent reduction in TB deaths and an 80 per cent reduction in the TB incidence rate by 2030, compared to the 2015 baseline. Milestones for 2020 include a 20% reduction in the TB incidence rate and a 35% reduction in TB deaths.
The UN Political Declaration on TB also included 4 new targets for the period 2018-2022:
- Treat 40 million people for TB disease
- Reach at least 30 million people with TB preventive treatment for a latent TB infection
- Mobilize at least US$13 billion annually for universal access to TB diagnosis, treatment and care
- Mobilize at least US$2 billion annually for TB research
The COVID-19 pandemic has reversed years of progress in providing essential TB services and reducing TB disease burden. Global TB targets are mostly off-track, although there are some country and regional success stories.
Globally, the number of people falling ill with TB each year (relative to population) dropped 11% from 2015 to 2020, just over half-way to the 2020 milestone of 20%
Globally, the reduction in the number of TB deaths between 2015 and 2020 was only 9.2% – about one quarter of the way to the 2020 milestone of 35%.
However, the WHO European Region exceeded the 2020 milestone, with a reduction of 25%. This was mostly driven by the decline in the Russian Federation, where incidence fell by 6% per year between 2010 to 2020. The WHO African Region came close to reaching the milestone, with a reduction of 19%, which reflects impressive reductions of 4–10% per year in South Africa and several other countries in southern Africa, following a peak in the HIV epidemic and the expansion of TB and HIV prevention and care.
The most obvious impact is a large global drop in the number of people newly diagnosed with TB and reported. This fell from 7.1 million in 2019 to 5.8 million in 2020, an 18% decline back to the level of 2012 and far short of the approximately 10 million people who developed TB in 2020.
The countries that contributed most to the global reduction in TB notifications between 2019 and 2020 were India (41%), Indonesia (14%), the Philippines (12%) and China (8%). These and 12 other countries accounted for 93% of the total global drop in notifications. Provisional data up to June 2021 show ongoing shortfalls.
WHO estimates that some 4.1 million people currently suffer from TB but have not been diagnosed with the disease or have not officially reported to national authorities. This figure is up from 2.9 million in 2019.
Reduced access to TB diagnosis and treatment has resulted in an increase in TB deaths. Best estimates for 2020 are 1.3 million TB deaths among HIV-negative people (up from 1.2 million in 2019) and an additional 214 000 among HIV-positive people (up from 209 000 in 2019), with the combined total back to the level of 2017. Declines in TB incidence (the number of people developing TB each year) achieved in previous years have slowed almost to a halt.
These impacts are forecast to be much worse in 2021 and 2022.
Other impacts include reductions between 2019 and 2020 in the number of people provided with treatment for drug-resistant TB (-15%, from 177 100 to 150 359, about 1 in 3 of those in need) and TB preventive treatment (-21%, from 3.6 million to 2.8 million), and a fall in global spending on TB diagnostic, treatment and prevention services (from US$ 5.8 billion to US$ 5.3 billion, less than half of what is needed).
There was also a reduction in provision of TB preventive treatment. Some 2.8 million people accessed this in 2020, a 21% reduction since 2019.
Actions to mitigate and reverse these impacts are urgently required. The immediate priority is to restore access to and provision of essential TB services such that levels of TB case detection and treatment can recover to at least 2019 levels, especially in the most badly-affected countries.
Funding in the low- and middle-income countries (LMICs) that account for 98% of reported TB cases remains a challenge. Of the total funding available in 2020, 81% came from domestic sources, with the BRICS countries (Brazil, Russian Federation, India, China and South Africa) accounting for 65% of total domestic funding.
The report notes a fall in global spending on TB diagnostic, treatment and prevention services, from US$ 5.8 billion to US$ 5.3 billion, which is less than half of the global target for fully funding the TB response of US$ 13 billion annually by 2022.
Meanwhile, although there is progress in the development of new TB diagnostics, drugs and vaccines, this is constrained by the overall level of R&D investment, which at US$ 0.9 billion in 2019 falls far short of the global target of US$ 2 billion per year.
Link to related World Health Organization news release: