As countries around the world — from Kenya to Canada, South Africa to Sweden — relish the prospect of an unofficial transition of Covid-19 from pandemic to endemic and start to ease pandemic-related restrictions, many of us in the tuberculosis (TB) community find it hard to relate. In TB, we know what can happen when a pandemic becomes an accepted fact.
Understandably, people everywhere are eager to return to normal. Covid-19, the thinking goes, has evolved to be milder, so it’s time to stop worrying and get on with our lives. Although the virus is still present, many think it has reached endemic levels and so restrictions are being lifted worldwide, despite warnings from more than a few epidemiologists.
There is no shortage of pandemics that continue to plague humanity. Malaria killed more than 620 000 people in 2020. TB was responsible for the deaths of more than 1.5-million people in 2020, and more than a third of these deaths took place in sub-Saharan Africa.
Prior to Covid-19, hope was on the horizon that the TB pandemic was beginning to ebb. Over the past decade, case rates and fatalities had been slowly declining while research and development efforts had yielded breakthroughs.
After forty years without new medicines approved to treat TB, three have been approved in the past decade. New technology can not only diagnose TB more easily and quickly than before, but also determine if the infection has any drug resistance. That counts as progress in the TB world — but there’s always the challenge of getting the technologies to the people who need it, and that’s where the Covid-19 pandemic really hit hard.
In 2020, the most recent statistics that we have for TB show that the number of deaths equals that of 2017, so five years of progress have been eliminated. An estimated 9.9-million people had TB infections, but only 5.8-million were diagnosed. We lost 10 years of progress in this benchmark. In addition, only about a third of the estimated 450 000 people with multidrug-resistant TB or Rifampin-resistant TB started treatment in 2020, a 15% decrease from the previous year.
In Africa, countries such as Nigeria, South Africa and Uganda had been making progress against TB, with deaths from the disease steadily declining, but these declines ended because of the Covid-19 pandemic and the related control measures.
In 2015, the world pledged to reduce deaths from TB by 90% by the year 2030, but we are nowhere close to achieving this goal. Epidemiologists evaluating the impact of this failure found that, before the Covid-19 pandemic began, sub-Saharan Africa had been hit hard by TB, with a heavy economic impact and significant loss of life.
The World Health Organisation (WHO) reports that, in sub-Saharan Africa, domestic spending on TB prevention, diagnostic and treatment services has declined over the past 10 years. It is no wonder the pressures of Covid-19 tore apart the TB safety net. In Africa, we decided it was okay to live with a lethal disease.
Yes, overall global spending on the disease is less than half of what it needs to be but for us in Africa, TB is not a disease of somewhere else. It is here, and we need to roll up our sleeves and fight back or it will never stop plaguing us.
No disease should be tolerated, especially deadly infections such as TB and Covid-19. All diseases need to be tackled with new technologies and the outreach needed to ensure that they are used appropriately. Endemic is never good enough.