The restrictions imposed on the population during the harshest years of the Covid-19 pandemic, between 2020 and 2022, were responsible for at least half a million deaths from tuberculosis that should not have occurred under normal circumstances. This is one of the conclusions of the Global Tuberculosis Report 2023 published this Tuesday by the World Health Organization (WHO). The document collects the latest global data on prevention, diagnosis, treatment, mortality and medical advances related to this disease, which in 2022 was the second global cause of death from a single infectious agent (behind the coronavirus) and which caused almost twice as many deaths. of deaths than HIV/AIDS.
Since the coronavirus became a global health emergency in March 2020, its effects and consequences have been numerous, whether direct, like the almost 15 million deaths worldwide in just two years, or collaterals. Among the latter, the prohibitions related to human and merchandise mobility caused, among other problems, that millions of people around the world could not be diagnosed with the ailments they contracted nor treated correctly.
It also happened with tuberculosis patients. They could not access health centers and services and this generated a decrease in the numbers of infections and also mortality. But already then, various international health organizations, led by the WHO, warned: this reduction was due to a more than likely underdiagnosis, given the difficulties caused by the ongoing pandemic.
And so it has been. When the ravages of covid-19 have been practically forgotten, the data have been able to be updated with more precision and the result is that there has been a significant global recovery in the number of patients diagnosed and treated: up to 7.5 million in 2022, the highest figure since the WHO began global monitoring of the infection in 1995. It is also above the pre-covid figure – and previous historical peak – of 7.1 million in 2019, and above 5 .8 million in 2020 and 6.4 million in 2021. In total, 34 million people in the world fight against this disease. “The 2022 figure likely includes a significant backlog of people who developed tuberculosis in previous years, but whose diagnosis and treatment were delayed by Covid-19-related disruptions that affected access to and delivery of health services,” the report reasons. of the WHO.
“The 2022 figure likely includes a considerable backlog of people who developed tuberculosis in previous years, but whose diagnosis and treatment were delayed by Covid-19-related disruptions,” the WHO report reasons.
The fact of being able to diagnose more and better, as before the pandemic, has helped reverse the impact of the number of deaths or illnesses. “In 2022, there was an encouraging recovery in the number of people diagnosed and treated, which has begun to reverse or mitigate the detrimental impact of the pandemic,” the authors of the report maintain.
However, in 2022 this infection claimed 1.3 million victims, almost at the pre-Covid level, and below the estimates of 1.4 million in both 2020 and 2021. “It is estimated that the interruptions related to covid-19 “have caused almost half a million excess deaths from tuberculosis in the three years 2020-2022, compared to the number that would have occurred if pre-pandemic trends had continued,” say the report’s authors.
Underdiagnosis, however, has continued to be a problem, since it is estimated that in 2022 some 10.6 million people will develop tuberculosis, that is, three million more than the new cases that were reported. The positive fact is that this gap is smaller than that which occurred during the worst years of the pandemic and is closer to the previous scenario. “It is possible that in 2023 or 2024 the downward trend will return,” predict the authors of the report.
Among the positive news, there has been some progress in the development of treatments, diagnostic tools and even vaccines, the director of the WHO Global TB Programme, Tereza Kasaeva, highlighted during a press conference this Tuesday. In addition, she also highlighted the launch of the Vaccine Acceleration Council last September to facilitate the development of new immunizations by seeking sustainable financing and alliances between different sectors.
The fact of being able to diagnose more and better, as before the pandemic, has helped reverse the impact of the number of deaths or illnesses
Catastrophic economic costs
Tuberculosis is caused by the bacillus Mycobacterium tuberculosis, usually affects the lungs—although not exclusively—and is spread when an infected person expels bacteria into the air when coughing, for example. Approximately a quarter of the world’s population has contracted the bacillus at some point, but only 5% end up developing the disease. This can be treated and cured, but if not, up to 50% of those affected can die.
Following the recommended treatment, 85% of those affected heal. However, the risk of not following it to the letter is developing the strain resistant to first-line drugs, which means switching to a longer drug regimen that produces greater side effects. In 2022, it is estimated that 410,000 people developed this type of multidrug-resistant infection and that those diagnosed who started treatment were 176,650, that is, only two out of every five patients could access a cure.
What’s more, approximately half of the patients and their families faced costs that were catastrophic for their economies, that is: between direct medical expenses and other indirect ones, such as loss of income due to being sick and not being able to work, tuberculosis It can take up to 20% of a household’s annual income.
Far from the SDGs
The data presented this Tuesday show that we are still very far from achieving the objectives set out in the Strategy End TB of the WHO in 2015, included in the Sustainable Development Goals (SDGs) that the member countries of the United Nations committed to meet that year. The milestone is that in 2025 deaths will have been reduced by 75%, but the reality is that between 2015 and 2022 there was a decrease, but only 19%. The same happens with incidence: the strategy contemplates a reduction in new cases of 50% and, however, since 2015 this decrease has been 8.7%. The European and African regions have made the most progress, with reductions of at least 20% in cases and 35% in mortality.
In terms of distribution, 87% of the cases in the world occurred in 30 countries, and two thirds of them in only eight: India (27%), Indonesia (10%), China (7.1%), Philippines (7.0%), Pakistan (5.7%), Nigeria (4.5%), Bangladesh (3.6%) and the Democratic Republic of the Congo (3.0%). 55% of those affected in 2022 were men, 33% were women and 12% were children between 0 and 14 years old.
By following the recommended treatment, 85% of those affected are cured. However, the risk of not following it to the letter is developing the variety resistant to first-line drugs.
To effectively combat tuberculosis, the WHO calls for faster progress towards universal health coverage and improved levels of social protection, as well as new national surveys and updated data on causes of deaths to make more precise estimates.
Financing continues to be an obstacle: in 2022, not even half of the 13 million dollars (approximately 12.1 million euros) that were estimated to be necessary for the provision of diagnosis, treatment and prevention services will be reached. “Although progress has been made in the development of new diagnostics, drugs and vaccines, the lack of funding is hindering research in these areas,” Kazaeva stressed. The director of the TB Program has assessed, however, that there are already at least 16 potential vaccines in different phases of clinical trials. “Our hope is that in five years we will have a more effective vaccine,” she commented. So far, the only one available is the so-called BCG, which is a century old and not very effective.
That is why, in this year’s report, WHO Director General Tedros Adhanom Ghebreyesus has called for an extra commitment to ending the disease. “For millennia, our ancestors have suffered and died from tuberculosis, without knowing what it was, what caused it, or how to stop it. Today we have knowledge and tools that they could only dream of,” he reflected. “We have a political commitment and an opportunity that no generation in the history of humanity has had: the opportunity to write the final chapter in the history of tuberculosis.”
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