Tuberculosis (TB) is one of the world’s leading infectious disease killers, preying on poor and marginalized communities. In 2020 alone an estimated 10 million people fell sick with the disease and 1.5 million people died. In countries where the Global Fund invests, TB deaths (excluding HIV-positive) have been reduced by 21% since the Global Fund was founded in 2002. But the COVID-19 pandemic is threating these hard-fought gains.
TB is spread from person to person through coughing and sneezing. One person with active, untreated TB can spread the disease to as many as 15 other people in a year. This makes the hunt for “missing cases” – those people currently not diagnosed, treated or reported – all the more urgent.
With our partners, we are making progress to end the disease as an epidemic. The number of people treated for TB has grown to over 14 million in 2018 and 2019. People provided with TB preventive treatment has also quadrupled since 2015, from 1 million in 2015 to 4.7 million in 2020.
COVID-19 is having a devastating impact on the fight against TB, as many essential resources – labs, testing machines, health workers – have been diverted to fight COVID-19. For the first time in the Global Fund’s history, we have seen significant declines in key programmatic results.
The pandemic has led to a dramatic reduction in TB testing, reversing years of progress in finding “missing people" with TB – people who go undetected, untreated, and unreported. COVID-19 is also especially dangerous for people with TB, as often their lungs are already damaged making them more vulnerable to the respiratory stress from COVID-19. The impact of COVID-19 on TB cases and deaths can be potentially devastating over the coming years.
But there is hope. Emergency funding from the Global Fund is helping countries fight both diseases. Investments are increasing in tools, health workers and systems for health to fight both TB and COVID-19 and prepare for future airborne pandemics. To prevent devastating long-term impacts on the fight against TB – and contributing to the spread of multidrug-resistant TB – we must urgently scale up adaptation and mitigation efforts to regain lost progress. Get the latest on our COVID-19 response.
In most cases, TB is treatable and curable. However, standard TB treatment requires up to six months of drugs that can cause nausea, vomiting and stomach pain. The duration and side effects drive some people to abandon their treatment, which can lead to drug resistance – when TB bacteria is resistant to at least one of the main TB drugs. In 2020, the number of people treated for drug-resistant TB dropped by 19%, while treatment for people with extensively drug-resistant TB fell by 37%, compared to 2019.
Drug-resistant TB is part of the growing challenge of antimicrobial-resistant superbugs that do not respond to existing medications, resulting in fewer treatment options and increasing mortality rates for illnesses that would ordinarily be curable – including TB. Multidrug-resistant TB now accounts for one-third of the world’s deaths from antimicrobial resistance.
Making TB screening routine can help reduce the stigma associated with the disease. Fear of being stigmatized often means people delay seeking help until seriously ill. Not only do they risk infecting those around them, but treatment takes longer and is less effective when the disease is in its advanced stages.
Prisoners, people living with TB/HIV coinfection, migrants, refugees and indigenous populations are highly vulnerable to TB, and experience significant marginalization, decreased access to quality services, and human rights violations. All people who have, or have survived, TB are considered as a key population for TB.
TB has stalked humanity for millennia. To turn the tables, we must turn to unconventional measures. Health partners in Tanzania have recruited an unlikely team of TB hunters: traditional healers, people recovering from drug use, and volunteer health workers who comb neighborhoods in the remotest parts of the country in search of the disease. Meet the people on the front lines of the fight.
About one-quarter of the world’s population has latent TB, but only about 5 to 15% develop symptoms of active TB. Individuals with compromised immune systems – such as people living with malnutrition, diabetes, HIV, or who use tobacco – have a higher risk of developing active TB.
HIV and TB are a deadly combination, as each fuels the progress of the other in infected patients. TB is the leading killer of people living with HIV; about 30% of deaths among people with HIV are due to TB. Those who are HIV-positive are up to 30 times more likely to develop active TB than those who are not, which is why it is vitally important, particularly in countries with a high burden of TB, that services for HIV and for TB be integrated. Every person who is HIV-positive should be screened and monitored for TB, and every person diagnosed with TB also needs to be tested for HIV.
The Global Fund provides 77% of all international financing for TB and has invested US$7.8 billion in programs to prevent and treat TB as of June 2021. A coalition of global health partners including the Global Fund is stepping up efforts to find more of the millions of people falling ill with TB who are missed by health systems.
About 30% of the Global Fund’s TB investments support interventions on TB care and prevention, particularly for children and other vulnerable groups such as people living with HIV. The Global Fund is supporting countries to remove human rights and gender-related barriers to health that have long blocked national responses to TB. In countries where the Global Fund invests, TB deaths (excluding those of HIV-positive people) have been reduced by 28%.