Need for increased research and financial investment to achieve the goal of eradicating TB by 2030.

1. Tuberculosis, one of the deadliest infectious diseases in the world

The world's thirteenth leading cause of death, tuberculosis (TB) is a bacterial infection caused by the bacterium "Mycobacterium tuberculosis" that primarily affects the lungs. The disease is spread by airborne transmission when a sick person coughs, spits or sneezes tubercle bacilli into the air that another person inhales. The World Health Organization (WHO) estimates that one quarter of the world population has latent TB infection and only 5-10% are likely to develop the disease. In the African region, 5 risk factors are attributable to infections, namely malnutrition (41%), HIV (36%), alcohol abuse (12%), smoking (6%) and diabetes (5%).

According to the integrated African Health Observatory (iAHO) TB Fact Sheet, between 2000 and 2019, 52 million people were infected with TB bacteria and about 7.5 million died from the disease in the WHO African Region. As such, 17 countries in the African region are included in the list of 30 countries in the world with a high burden of TB.

2. The ambitious challenge of eradicating TB by 2030

Recognized since 1993 as a global public health emergency by the WHO, tuberculosis is not only a public health problem but also has social and economic implications. For these reasons, the disease is among those that the Member States of the United Nations (UN) intend to eradicate by 2030 (Sustainable Development Goal 3.3). To this end, the WHO's ambitious strategy to eradicate the epidemic by 2030 calls for reducing the incidence of TB by 80%, reducing TB deaths by 90%, and ensuring that no TB-affected household incurs catastrophic costs related to the disease.

However, as highlighted by the Director of the WHO’s African Region, Dr. Matshidiso Moeti, on World TB Day 2022, achieving this goal in the African Region seems unrealistic at this point. Indeed:

“To reach the target, TB incidence would have had to record an annual decline of 4% to 5% in 2020, increasing to 10% per year by 2025, and then to an average 17% annually in the following decade. In fact, the world saw an increase in the number of global TB deaths for the first time in over a decade in 2021. Contributing factors included reduced access to TB diagnosis and treatment, in the face of the COVID-19 pandemic.”

The COVID-19 pandemic has greatly impacted the fight against tuberculosis in the region. A policy brief developed by WHO/AFRO on the "effects of COVID-19 on tuberculosis healthcare service delivery" shows that due to containment measures, there has been a decline in patients visiting health services for fear of contracting the COVID-19 virus, as well as a decrease in testing. In addition, several TB treatment centres have been converted to COVID-19 isolation and management centres. The GeneXpert machines used for TB testing are also used for COVID-19 testing, resulting in a backlog of TB tests.  Moreover, funding for TB research, diagnosis and treatment has also been reduced to support COVID-19 pandemic programs.

It is also important to mention that many households still suffer from significant costs related to TB treatment. By 2020, according to the TB eradication strategy, the region was supposed to have reduced to 0% the number of households facing catastrophic costs related to the disease. However, the TB fact sheet shows that by 2020 only 8 countries had achieved this goal. In some countries in the region, the percentage of catastrophic costs ranges from 11  o 80 percent, with Zimbabwe having the highest percentage in the region.

3. "Invest to End TB. Save lives."

The theme for World TB Day 2022 is " Invest to End TB. Save Lives." Indeed, this year, the focus is on the need to invest more in research and financial investments to achieve the goal of eradicating the disease by 2030.

As highlighted by Dr. Moeti, "With 36% of all TB deaths occurring in Africa, failure to invest in the TB response is set to take a formidable toll on African countries. Increased investment can be a game-changer, and alleviate the preventable suffering and death of millions of our people.”

In this regard, the Global Fund to Fight AIDS, Tuberculosis ana Malaria, one of the major international donors of programs to fight the disease, has launched a campaign to replenish its resources, “aiming to raise at least US$18 billion to fight TB, HIV and malaria, build stronger systems for health and reinforce pandemic preparedness.”

Beyond financial investments, research also plays an important and critical role in the fight against the disease. As Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, points out, "urgent investments are needed to develop and expand access to the most innovative services and tools to prevent, detect and treat TB that could save millions of lives each year, narrow inequities and avert huge economic losses.”

To learn more about tuberculosis:

1.           WHO Global Tuberculosis Report

2.           The end TB strategy

3.           iAHO Fact Sheet on TB in the African Region

4.           WHO operational handbook on tuberculosis Module 5: Management of TB in children and adolescents