Maintaining Momentum in TB Achievements: Leveraging progress and lessons across the responses to TB and COVID-19

While every year World TB Day falls on March 24, this year, another airborne infectious disease has overwhelmed our lives and consciousness. Communities and health care personnel around the world are making efforts to prevent COVID-19 from overwhelming their health systems. This attention to health systems is an opportunity to acknowledge similar gaps in the global response to tuberculosis, while ensuring that efforts to end TB continue, and that the COVID-19 control efforts benefit from successes in the TB response.  

More than one-quarter of the world’s population is infected with tuberculosis, and in 2018, there were an estimated 10 million cases of active TB disease. Of these, only 7 million cases were actually detected and linked to the health system. This gap can be attributed to a lack of case-finding and expedient and efficient diagnostics. Other barriers to TB control are a surge in drug resistance, co-infection with HIV, and the perpetration of stigma toward patients, often by health care providers themselves. These factors are part of the reason that 4,000 people still die from TB each day. 

Despite these bleak numbers, the TB mortality rate declined by 38% from 2000 to 2018, and the treatment success rate for newly diagnosed cases is 85%, accomplishments that reflect years of hard work by the TB community. 

As countries grapple with COVID-19 and try to ensure that their health systems have the strength and capacity to respond effectively, we can learn from global TB interventions that have expanded testing and active case-finding efforts; increased efforts to trace contacts of infected patients; improved infection prevention and control mechanisms; implemented practices that help reduce the spread of the disease within communities and protect health workers who care for TB patients; and helped people who have TB cope with experiences of stigma and isolation. As Dara, Sotgiu et al. point out in a recent article, “Complementary COVID-19 and TB responses can assist in curbing both epidemics to save lives.”

Symptoms of active TB are, in some ways, similar to those indicating COVID-19 infection, necessitating clear guidance and differentiated approaches to TB diagnosis in the time of COVID-19, and raising questions of how resources (human, laboratory, and financial) will be used to manage both diseases. 

In countries that have a low burden of TB, such as the U.S., Canada, and much of the European Union, people who have a cough are more likely to be concerned about having COVID-19 than TB. But in India, Uganda, and Kyrgyzstan, for example, people who have a cough may be more concerned about TB, or they may be concerned about both and unsure how to seek care appropriately. 

What care-seeking guidance should we provide? 

Since health care workers who have experience in TB and other respiratory illnesses are likely to be conscripted for a possibly staggering number of patients who have COVID-19, who will be available to diagnose people who have TB, initiate them on treatment, and support them through a long and often challenging treatment phase? 

These and other questions, such as how a person’s TB status affects his/her risk for COVID-19, how access to TB treatment will be altered by the COVID-19 response, and what the implications of TB and COVID-19 coinfection will be, are among myriad concerns for TB patients, health workers, and program managers alike right now. 

As we get more information to answer these questions and respond accordingly to both diseases, we will certainly be confronted again by the gaps that have developed or lingered within our health systems, but we will also learn (or be reminded of) critical and possibly humbling lessons about the value of investing in equitable approaches that promote early care-seeking, emphasize basic prevention and protection, and prioritize identification, diagnosis, treatment, and support of the most vulnerable among us. 

As Lucica Ditiu, director of the Stop TB Partnership said in Madhukar Pai’s article in Forbes, “The control of COVID-19 can benefit from the work TB programs have done over the years in areas such as infection control, diagnosis, contact tracing, and isolation.” Pai himself went on to acknowledge the potential for reciprocal gains when he noted that “the reverse might also work; any investments made in COVID-19 control should be leveraged for TB care, after the pandemic subsides.” 

Across the world, COVID-19 is amplifying the message that the TB community has been repeating since Robert Koch discovered the TB bacteria in 1882: governments must provide the basic building blocks of health systems: services that meet people’s needs; a well-trained workforce; information systems that provide accurate and useful data; a strong supply chain that ensures access to essential medicines; ample and intractable financing; and strong leadership. It’s time to heed that message and build on prior hard-won successes to bolster health systems and improve the lives of people who are vulnerable to or suffering from TB, COVID-19, and other infectious diseases.

Written by Sabrina Eagan and Nikki Davis