By Henrylito D. Tacio
Before the coronavirus disease 2019 (COVID-19), the number of people falling ill with tuberculosis (TB) has been steadily declining. But disruptions caused by the pandemic has reversed years of progress in the fight against the ancient scourge, according to the 2022 Global TB Report.
An estimated 10.6 million people around the world fell ill with tuberculosis in 2021, an increase of 4.5% from 2020, and 1.6 million people died from TB (including 187 000 among HIV positive people), the WHO report said.
The burden of drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB (RR-TB) in 2021. “This is the first time in many years an increase has been reported in the number of people falling ill with TB and drug resistant TB,” the WHO report said.
According to the United Nations health agency, TB services are among many others disrupted by the COVID-19 pandemic in 2021, but its impact on the TB response has been particularly severe.
In the Philippines, for instance, there was an estimated incidence of 591,000 TB cases in 2020. However, only 44.5% of cases were notified. A drop of 37% in the number of notifications in comparison to the previous years – 419,102 cases in 2019 versus 263,300 cases in 2020 – reflects how COVID-19 affected the continuity of TB services.
“When we went into lockdown, we were suddenly unprepared,” admitted Arnyl Araneta, program manager for the Advancing Client-centered Care and Expanding Sustainable Services for TB, a program funded by the Global Fund and implemented through the Philippine Business for Social Progress.
But the Philippines was not alone in this dilemma. It also happened in almost other parts of the world.
“If the pandemic has taught us anything, it’s that with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threats. Let’s apply those lessons to tuberculosis. It is time to put a stop to this long-time killer. Working together, we can end TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
While there is TB in every part of the world, 30 countries carry the highest burden. In Southeast Asia, TB is more prevalent in Indonesia, Myanmar, the Philippines, Thailand and Vietnam.
In the June 2022 issue of The Lancet, the Philippines was ranked the “fourth largest contributor to the number of tuberculosis worldwide” – after India, China and Indonesia. About “500 people per 100,000” people are affected.
TB is not a new disease. It has remained a public health challenge from ancient times. As early as 460 BC, Hippocrates, the famous Greek physician identified TB as a widespread and highly fatal disease. At that time, no one knew what caused TB and how to treat it. TB spread uncontrollably killing most of its victims.
TB is sometimes regarded as a romantic 19th century disease. Famous victims include fiction writer Edward Bellamy, poet Elizabeth Barrett Browning, novelist Franz Kafka, composer Frederic Chopin, inventor Alexander Graham Bell, entertainer W.C. Fields, and nurse Florence Nightingale, who all died of TB.
Brazilian poet Manuel Brandeira contracted TB in 1904 andexpressed the effects of the disease in his life in many of his poems. American author Dashiell Hammet got the disease during World War II. American country composer Jimmie Rodgers sang about the woes of TB and ultimately died of the disease days after a New York City recording session.
World leaders were not spared from TB: Charles IX of France, Edward VI of England, American presidents Ulysses S. Grant and Andrew Jackson, Louis XII of France, Napoleon II of France, Pedro I of Brazil, and Manuel L. Quezon of the Philippines.
Today, TB is still one of the deadliest infectious killers. Scientists discovered that it is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. It can spread when people who are sick with TB expel bacteria into the air – for example, by coughing.
Most people who develop the disease in 2021 are adults: men accounted for 56.5% of the TB burden, adult women accounted for 32.5% and children for 11%. Many new cases of TB are attributable to five risk factors: undernutrition, HIV infection, alcohol use disorders, smoking and diabetes.
TB is preventable and curable. About 85% of people who develop TB disease can be successfully treated with a 4/6-month drug regimen; treatment has the added benefit of curtailing onward transmission of infection.
Economic and financial barriers can affect access to health care for TB diagnosis and completion of TB treatment; about half of TB patients and their households face catastrophic total costs due to TB disease.
Progress towards universal health coverage (UHC), better levels of social protection and multisectoral action on broader TB determinants are all essential to reduce the burden of TB disease, the WHO said. – ###
