COVID-19 reverses decades of progress in TB elimination, India worst-hit: WHO

Source: This post is based on the article “COVID-19 reverses decades of progress in TB elimination, India worst-hit: WHO” published in Down To Earth on 14th  October 2021. 

What is the News? 

World Health Organization (WHO) released “Global TB report” which stated that the world suffered huge reverses in progress towards tuberculosis (TB) elimination in 2020, due to COVID-19 pandemic. India has been the worst-hit. 

What are the key findings of the report? 

Detection of new cases-The biggest impact was felt in terms of detection of new cases. From 2016-2019, the number of new cases rose continuously, but fell to 20% in 2020. This was due to cases going undetected because of lack of access during the pandemic.  

India contributed the biggest drop in detection of new cases. Some 41% of the total number of cases that dropped in 2020, as compared to 2019, came from India. From 2013-19, the gap between the people actually infected and correctly diagnosed with the TB decreased continuously and India and Indonesia were the biggest contributors to this achievement. Now, these very countries are the two biggest laggards. 

Increase in TB deaths- Overall, the deaths have gone back to the level of 2017.people dying with TB without HIV co-infection and those who suffered with HIV co-infection registered increased number of deaths in 2020. 

Death globally- TB was ranked the 13th leading cause of death till 2019. Because of the huge setbacks, it is now estimated to be the second leading cause, only after COVID-19. 

Drug-resistant TB- Number of people provided with treatment for drug-resistant TB went down by 15 per cent in 2020, as compared to the previous year. However, the burden of multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) remained stable. 

What are the reasons cited for this condition? 

Report includes both supply- and demand-side disruptions to TB diagnostic and treatment services. 

A large number of cases went undetected due to highly curtailed access to diagnostics and restrictions imposed to contain the pandemic. 

Reduced health system capacity to continue to provide services. 

Less willingness and ability to seek care in the context of lockdowns and associated restrictions on movement. 

Concerns about the risks of going to healthcare facilities during the pandemic. 

Stigma associated with similarities in the symptoms related to TB and COVID-19. 

What are the milestone targets on TB to be achieved? 

‘End TB Strategy’ milestones 

TB disease burden- A 35% reduction in the number of TB deaths by 2020 was the target. However, the global reduction in the corresponding time period has only been 9.2 per cent. 

TB incidence rate- Strategy aimed to reduce the TB incidence rate to 20% by 2020, as compared with the levels in 2015. But the target achieved till 2020 was only 11%. 

Preventive treatment- People suffering from conditions that make them vulnerable to TB, particularly an HIV infection, are also provided preventive treatment. This segment also saw a decline. 

What is the expected future trend? 

Due to spillover effects, the years 2021 and 2022 can see further deterioration in TB condition. TB mortality in 2021 is projected to be much higher than in 2020 in all of the 16 countries that accounted for almost all of the global drop in TB notifications. 

To improve the diagnosis, the report said countries need to increase testing through bacteria culture or rapid tests. The share of rapid tests especially needs to go up as only 33 per cent of total cases were diagnosed through it.