The World Health Organization (WHO) have used World Tuberculosis (TB) Day, which fell on 24 March 2022, to call for an urgent investment of resources, support, care and information into the fight against TB. Although 66 million lives have been saved since 2000, the COVID-19 pandemic reversed those gains and, for the first time in over a decade, TB deaths increased in 2020. Ongoing conflicts across Eastern Europe, Africa and the Middle East have further exacerbated the situation for vulnerable populations.
Global spending on TB diagnostics, treatments and prevention in 2020 were less than half of the global target of US $13 billion annually by 2022. For research and development, the WHO believe an extra US $1.1 billion per year is required, in order to develop and expand access to the most innovative services and tools to prevent, detect and treat TB which could save millions of lives each year, narrow inequities and avert huge economic losses. The WHO believe investments in TB programmes have demonstrated benefits not just for people with TB but for health systems and pandemic preparedness. Building on lessons learnt from COVID-19 research, there is a need to catalyse investment and action to accelerate the development of new tools, especially new TB vaccines.
Progress towards reaching the 2022 targets set in the UN High Level Meeting political declaration and the WHO Director-General’s Flagship Initiative is at risk mainly due to lack of funding. Between 2018 and 2020, 20 million people were reached with TB treatment, which is 50% of the five-year target of 40 million people reached with TB treatment for 2018 to 2022. During the same period, 8.7 million people were provided TB preventive treatment, which is 29% of the target of 30 million for the same period.
The situation is even worse for children and adolescents with TB. In 2020, an estimated 63% of children and young adolescents below 15 years of age with TB were not reached with, or not officially reported, to have accessed life-saving TB diagnosis and treatment services, with the proportion being even higher (72%) for children under five years of age. Almost two-thirds of eligible children under five years of age did not receive TB preventive treatment and therefore remain at risk of illness.
COVID-19 has had a further negative and disproportionate impact on children and adolescents with TB or at risk, with increased TB transmission in the household, lower care-seeking and access to health services. The WHO is urging countries to urgently restore access to TB services, disrupted due to COVID-19 pandemic for all people with TB, especially children and adolescents.
Prior to World TB Day, on 21 March 2022, the WHO published updated guidelines for the management of TB in children and adolescents to highlight new patient-centred recommendations for diagnosis, treatment and prevention. The following list covers the most recent recommendations.
- Diagnostic testing has expanded to include non-invasive specimens, such as stools.
- Rapid molecular diagnostics are recommended as the initial test for TB diagnosis for children and adolescents.
- Children and adolescents who have non-severe forms of drug-susceptible TB are now recommended to be treated for four months instead of six months, as well as TB meningitis, where a six-month regimen is now recommended instead of 12 months. This promotes a patient-centred approach that will reduce the costs of TB care for children, adolescents and their families.
- Two of the newest TB medicines to treat drug resistant TB, bedaquiline and delamanid, are now recommended for use in children of all ages, making it possible for children with drug-resistant TB to receive all-oral treatment regimens regardless of their age.
- New models of decentralized and integrated TB care are also recommended, which will allow more children and adolescents to access TB care or preventive treatment, closer to where they live.
It should be noted that TB remains one of the world’s deadliest infectious killers, with over 4,100 people losing their lives and close to 30,000 people falling ill with this preventable and curable disease.
More information on World TB Day can be found on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.
Source: WHO, 21 March 2022