COVID-19 has made TB even more of a forgotten pandemic

The rapid and unprecedented national and international response to Covid-19 after he virus was first reported in December 2019 led to massive R&D outlays. In 2020 alone, well over $100 billion was spent on Covid-19 diagnostics, vaccines, and therapeutics. Judging from the numbers of products developed at warp speed, the money was well spent. SARS-CoV-2 was first sequenced in January 2020. Since then, at least 25 vaccines have been licensed for use worldwide.

On the other hand, tuberculosis was first identified in 1882. Since then, a grand total one vaccine has been registered for use to prevent tuberculosis. In 2020, total research funding worldwide for tuberculosis was less than $1 billion.

For the first time in more than a decade, tuberculosis mortality increased in 2020; from 1.4 to 1.5 million deaths. Preliminary World Health Organization (WHO) modelling projections indicate the number of tuberculosis deaths could be substantially higher in 2021 and 2022.

Because the distribution of tuberculosis has invariably been highly skewed towards developing nations and so-called emerging market countries, pharmaceutical firms haven’t exactly prioritized drug development targeting the disease. As a result, tuberculosis has been mostly a forgotten pandemic, in spite of its status as a global health emergency since 1993 when the WHO declared it as such.

Since 2000, philanthropic foundations, non-governmental organizations, and government agencies, such as the U.S. Agency for International Development, have picked up some of the slack. From the Gates Foundation to Médecins Sans Frontières to the TB Alliance and many others, resources allocated towards case detection and treatment, as well as drug and vaccine development, have increased. Several large pharmaceutical companies have also responded to the call for additional funds to be poured into R&D, particularly with respect to the big three infectious diseases. Some of the collaborative work has paid off. In 2012, Sirturo (bedaquiline) was approved as the first new therapeutic agent indicated for tuberculosis in 50 years.

But, while more attention has been devoted to tuberculosis in the last 20 years, it is still one of the world’s deadliest diseases. Worldwide, tuberculosis is now the second leading infectious disease killer after Covid-19. And since 2000, tuberculosis has killed more than 20 million people.

By suspending non-Covid-19 related healthcare services, the Covid-19 pandemic has disproportionately impacted tuberculosis. As resources have been diverted towards Covid-19, tuberculosis case detection and treatment have steadily decreased. Furthermore, Covid-19 has crowded out non-Covid-19 related R&D dollars.

The figures for 2020 reveal a 15% reduction in the number of people treated for multi-drug resistant tuberculosis, a 21% decrease in people receiving preventive treatment for tuberculosis infection, and a 9% decrease (from $5.8 billion to $5.3 billion) in global spending on tuberculosis. WHO estimates that approximately 4.1 million people currently suffer from tuberculosis but have not been diagnosed with the disease, and accordingly haven’t been recorded in official reports.

As a consequence, progress toward the 2022 targets established by the United Nations and WHO won’t be met.

Experts fear that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis.

Tuberculosis's continued long-term endemicity - if we want to call it that - entails a steady tally of fatalities and burden of disease that have lasted for many decades. Additionally, even those who survive tuberculosis face a significant chance of experiencing disability and elevated mortality risks.

Some good news

All is not doom and gloom with tuberculosis. The good news is that there are now more therapeutics available to treat tuberculosis. We mentioned the approval of bedaquiline in 2012. Also, in 2019, the combinations bedaquiline/pretomanid/linezolid (BPL) and bedaquiline/pretomanid/linezolid/moxifloxacin (BPLM) were approved for highly treatment-resistant tuberculosis.

On May 2nd of this year, WHO announced that it was recommending 6-month, all-oral regimens of BPL and BPLM, rather than lengthy - 8-24 months - and more toxic, injectable treatments of multi-drug resistant tuberculosis.

The WHO’s Global Tuberculosis Program’s updates to guidance regarding the treatment of multi-drug (including rifampicin) resistant tuberculosis will inform national tuberculosis programs.

Of course, now the question looms, do countries have sufficient financial wherewithal to purchase the medicines and distribute them to clinics and hospitals? Here, funding in the low- and middle-income countries that account for 98% of reported tuberculosis cases remains the biggest challenge. Some have the resources, but others don’t. And so, what needs to happen is a restoration of essential tuberculosis services to pre-Covid-19 levels to get prevention, diagnosis, and treatment efforts back on track. For this purpose, the recent decline in global spending on case detection, treatment, and prevention must be reversed.

Source: Forbes