As governments around the world struggle to contain spiraling infections and an ever-increasing death toll from COVID-19, it’s worth reflecting on what lessons we can draw from the long and still unfinished fight against tuberculosis – the world’s most deadly infectious disease that kills nearly 1.5 million per year.
The first is the harsh truth that when a disease stops killing people in rich countries, the money dries up and momentum slows. In the first half of the 20th century TB was the biggest killer across Europe, North America and Japan. Massive campaigns, the deployment of antibiotics and overall improvements in public health saw TB almost disappear in the advanced economies. Elsewhere, however, TB is still astonishingly prevalent. Nearly one-third of the world’s population have latent TB, carrying the bacteria while not showing symptoms, while nearly 10 million a year fall ill – of which 15% die. Nowadays, TB is disproportionately a disease of the poor, the marginalized, those without a voice. You find it in slums, in prisons, in refugee camps, amongst the rural poor, amongst those living with HIV.
Yet despite being responsible for more deaths than any other infectious disease, TB attracts far less money and attention. Investing about US$700m per year, the Global Fund is by far the biggest source of external funding, providing almost 70% of total international assistance to countries fighting TB. That’s less than the annual budget of a large hospital in London or New York. It should be no surprise that we’re not on track toward the Sustainable Development Goal target of ending the epidemic by 2030.
The second lesson is that pathogens are constantly mutating to become more dangerous. Multidrug-resistant TB, known as MDR-TB, can’t be treated with conventional antibiotics, and requires much more expensive treatment over 6-9 months, often with nasty side effects. Worse, most of those contracting MDR-TB never get properly diagnosed and almost half die. MDR-TB has been described as “Ebola with wings”: equally fatal, much more contagious, and already affecting about 500,000 people per year in every region of the world.
While countering COVID-19 is the immediate imperative, we must seize this opportunity to radically rethink our approach to global health security. We must break out of the cycle of panic and neglect that’s characterized our approach thus far.
A more positive lesson from the fight against TB is that even the most formidable disease can be beaten. TB has become relatively rare in the advanced economies. Overall deaths from TB have fallen by approximately 40% between 2000 and 2018. The numbers of “missing” people with TB – those who are neither diagnosed nor treated – has fallen sharply since 2018. New treatments for MDR-TB are significantly improving survival rates. The Global Fund, along with partners like WHO, the Stop TB Partnership and Unitaid, has played a critical role in these achievements, investing in innovative approaches to finding, diagnosing and treating hard-to-reach TB patients, and funding the rapid roll-out of new MDR-TB diagnostics and treatments.
Two other factors link TB and COVID-19. The first is the obvious point that both are respiratory conditions. While we are still learning about COVID-19, evidence suggests that people with TB will be among the most vulnerable. TB affects many of the same people at risk of COVID-19: people with underlying autoimmune diseases or chronic respiratory illnesses, people who can’t afford or access health care, people in close quarters and poor hygiene like prisons, slums and refugee camps. Getting COVID-19 if you already have TB is going to be dangerous.
The second is that some of the tools we are using to fight TB may play a vital role in the fight against COVID-19. For example, in most of the poorest countries, the most widely distributed molecular diagnostic devices are Cepheid’s GeneXpert instruments funded by the Global Fund. We have installed over 10,000 of these devices in laboratories across low- and middle-income countries and have trained technicians to operate them. With the announcement on Saturday that Cepheid had received FDA approval for a COVID-19 cartridge for these instruments, we see an opportunity to help countries massively expand their COVID-19 testing capacities, as long as production capacities and pricing permit this.
As the world mobilizes to contain COVID-19, we must learn from the way we’ve fought other diseases. Removing human rights barriers to health care, addressing stigma directed toward at-risk groups and people with the disease, and recognizing the importance of communities in supporting health systems and people affected are critical to an effective response.
We must also recognize the powerful interactions between this new pandemic and existing epidemics. If we don’t act to mitigate the threat, COVID-19 could lead to an upsurge in TB deaths. If we take an integrated approach, leveraging the infrastructure and resources we’ve already invested in and moving swiftly to strengthen the health system as a whole, we can step up the fight against both threats.
The Global Fund is committed to helping the most vulnerable countries fight the three infectious diseases currently killing the most people across the world – HIV, TB and malaria – and to helping the same countries and communities respond to COVID-19. This is not a choice between one or the other. We must do both.
This op-ed was first published by the Thomson Reuters Foundation.