In India, a doctor checks a patient’s x-ray for lung damage, which may indicate tuberculosis. Credit: ILO/Vijay Kuty
 
On May 8, there will be an interactive multistakeholder hearing at the UN as part of the preparatory process toward High-level meeting on the fight against tuberculosis. The event will be broadcast live on UN Web TV.
 
Meanwhile, the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, has unveiled plans to speed up the licensing and use of effective novel vaccines against tuberculosis (TB), the second leading infectious killer after COVID-19 and the 13th leading cause of death worldwide. January 2023

By Morounfolu Olugbosi
PRETORIA, South Africa, May 8 2023 (IPS)

This week, the United Nations will host two days (May 8-9) of preliminary talks to plan a larger conference on tuberculosis (TB) in September. These preliminary talks will be held in New York City, the epicenter of the last significant surge of TB cases in the United States (U.S.) thirty years ago.

TB is a disease that strikes hardest in impoverished places, and the last U.S. outbreak was no different. Disadvantaged urban communities hit hard by the HIV/AIDS pandemic bore the brunt of the outbreak.

Yet, at the outbreak’s peak in 1992, less than 27,000 people in the U.S. were infected with TB. Today, an estimated 304,000 people are infected with TB in South Africa every year, while just under 3,000,000 people are infected with TB in India. The scope of the disease today far exceeds what the U.S. saw three decades ago, much less what it sees now.

TB deaths have risen across the world for two consecutive years; at this point it kills more people than COVID-19. Globally, an estimated 10.6 million people were infected with TB, but only 6.4 million people were diagnosed. The other 4.2 million people infected with this potentially lethal and debilitating disease slipped through the cracks.

In 2018, the UN held the first high-level meeting on TB. More than half of the UN member states sent delegations and 15 heads of state spoke at the event.

In a resolution endorsed by the entire UN General Assembly, every nation pledged to invest, by 2022, a total of US$2 billion annually for TB research and US$13 billion annually for TB diagnostics, treatment and care. Other commitments—to treat more people and prevent more active disease—were also made.

The world got off to a slow start on meeting these pledges and then the pandemic hit. Many of the goals were not reached. We were delighted, for example, that the annual research budget for TB research finally reached US$1 billion in 2021, because it was a critically important achievement—but the actual goal was twice that amount.

And less than half of what was pledged annually on diagnostics, treatment and prevention—US$5.4 billion—was actually provided in 2021.

There are bright spots in the fight against TB, of course. Sub-Saharan Africa is the only region that did not suffer a significant slump in TB detection during the COVID-19 pandemic. But with just under 40% of active TB infections unidentified, it still lags behind much of the world in diagnosing active cases.

Another recent highlight is the approval of new drug-resistant TB treatments that can reduce treatment time from as much as a year and a half (or sometimes even longer) to six months—including one developed by my organization, TB Alliance. African nations like Nigeria and South Africa are taking steps to rolling out this new regimen so that the spread of drug resistant infections can be curbed.

The goal pledged at the 2018 UN meeting was that, between 2018 and 2022, 1.5 million people with drug-resistant TB (DR-TB) would be treated—this is a critical slice of the TB caseload. Yet only 649,000 DR-TB patients were treated between 2018 and 2021.

There is optimism that the number of DR-TB patients who can be treated will escalate, given the new treatments, but funding and resources must increase.

The bottom line is this: TB was the most lethal infectious disease before the COVID-19 pandemic, and as COVID recedes, it is once again the worst. As leaders prepare to meet in New York City and start drafting a new set of promises in the form of the next Political Declaration on TB, we need the world to commit to ending this disease, which has killed too many people for far too long.

But this time around, we also need the world to follow through on its commitments.

Morounfolu (Folu) Olugbosi, M.D. is the Senior Director, Clinical Development at TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.

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In Africa only 60% of the estimated TB cases have been diagnosed. All the other infections are hidden by poverty—and so the disease continues to spread. Credit: Jeffrey Moyo/IPS.

By Morounfolu Olugbosi
JOHANNESBURG, Nov 8 2022 (IPS)

The news in many parts of the world is that tuberculosis (TB) is reclaiming the title of the world’s most deadly infection, even as the COVID-19 pandemic continues to kill an estimated 1,450 people daily around the world. But this is not news to African countries, which are home to one third of the people globally who die from TB, even though they have less than one fifth of the world’s population.

And on our continent, the real burden might be worse: only 60% of the estimated cases have been diagnosed. All the other infections are hidden by poverty—and so the disease continues to spread.

Consider Zanyiwe’s story, who is recovering from TB a fifth time. Her son-in-law died from the disease, and her 18-month old granddaughter has it currently. TB has hammered her family and her community in Cape Town, South Africa—but this story could be set in Nigeria, Kenya, or just about anywhere, as TB has never been contained in Africa.

Four years ago, there was hope that TB might be receiving the attention it deserves. The United Nations held a High-Level Meeting with heads of state in September 2018 where more than half of the world’s nations convened to rally support to tackle TB. Many pledges were made; fulfillment of these pledges got off to a slow start and then the COVID-19 pandemic derailed things completely.

The first commitment was to find and treat 40 million people with TB between 2018 and 2022, including 3.5 million children and 1.5 million people with drug-resistant TB. We’re 19% behind that overall goal, but 32% behind with children and 46% behind with drug-resistant TB. We now have new and shorter treatment regimens for TB and drug-resistant TB; using these new technologies could make next year, when another UN high level meeting on TB will convene, a different story.

The second commitment was to provide preventive treatment for 30 million people at risk for TB infections. We’re 48% behind here; while we already exceeded the sub-target of reaching 6 million people with HIV with preventive treatment, from 2018-2021 we’ve only provided preventive treatment to 2.2 million household contacts of people with TB, 11.5% of the goal. Once again, we now have new, more effective and shorter preventive regimens to deploy—but we need the outreach capacity and willingness of countries to get the treatment into the hands of the people who need it.

The third and fourth commitments are about funding. Leaders pledged to spend a total of US$13 billion annually on prevention, diagnosis and treatment by 2022; in 2021 only 42% of that yearly goal was spent. For TB research, US$2 billion annually was pledged by 2022 but in 2021 research spending reached less than half that amount (46%). Rolling out the new treatments and developing even better ones will require a stronger embrace of these commitments; the status quo simply will not get us there.

While we have yet to finish 2022, it is obvious that we will not meet these goals. With that being said, there have been signs of progress worth drawing attention to.

First, Gabon, Kenya, Liberia, Namibia, Republic of Congo, Sierra Leone, and Uganda all made progress in finding more cases of TB last year. And Central African Republic, Democratic Republic of Congo, Mozambique, Nigeria, Tanzania, and Zambia have all made progress throughout the pandemic—showing the political will needed to keep their people healthier. Overall, Africa found 4% more TB in 2021 than in 2020. It’s a start—and we can do better.

New TB medicines are being supported by the World Health Organization (WHO). Six-month therapy for drug-resistant TB has been approved in more than 20 countries, including the Democratic Republic of Congo, Mozambique, South Africa, and Zimbabwe. And Ethiopia, Ghana, Kenya, Malawi, Mozambique, South Africa, Tanzania, and Zimbabwe are working to roll out a new TB prevention treatment.

In Africa, we will not mistake these initial signs of progress for anything more significant. Yet, at the same time, it is still progress to be respected and built upon. Next year, the world will consider their long-ignored pledges. We need to show the world that it is time to move forward; all that’s been missing is the same thing that’s been missing for far too many years: political will.

Morounfolu (Folu) Olugbosi, M.D. is the Senior Director, Clinical Development, TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.

There is no shortage of pandemics that continue to plague humanity. 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. Credit: Athar Parvaiz/IPS

By Morounfolu Olugbosi
JOHANNESBURG, Mar 29 2022 (IPS)

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 four decades without new medicines approved to treat TB, three have been approved in the past ten years. 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.

Dr.Morounfolu (Folu) Olugbosi

In 2020, the most recent statistics that we have for TB, the number of deaths equals that of 2017, with five years of progress eliminated. An estimated 9.9 million people had TB infections, but only 5.8 million were diagnosed. We lost ten years of progress in this benchmark. And only about one third of the estimated 450,000 people with multi-drug resistant TB or Rifampin-resistant TB started treatment in 2020, a 15% decrease from the previous year.

In Africa, countries like Nigeria, South Africa and Uganda had been making progress against TB, with deaths from the disease steadily declining, but these declines ended—all because of the COVID-19 pandemic and related control measures.

In 2015, the world pledged to reduce deaths from TB by 90% by the year 2030, and 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 from failing to meet this ambitious benchmark.

And yet, the World Health Organization (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. We too, in Africa, had decided it was ok 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 will never stop plaguing us.

No disease should be tolerated, especially deadly infections like TB and COVID-19. All diseases need to be tackled with new technologies and the outreach needed to make sure they are used appropriately. Endemic is never good enough.

Dr. Morounfolu (Folu) Olugbosi, M.D. is the Senior Director, Clinical Development, TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.

COVID-19 cancelled out the last 12 years of advancements in finding and treating people with TB. Credit: Jeffrey Moyo/IPS.

By Morounfolu Olugbosi
JOHANNESBURG, Oct 21 2021 (IPS)

Before COVID-19 came along, tuberculosis (TB) was a primary focus of health authorities in sub-Saharan Africa. In 2019, approximately 1.4 million people were diagnosed with TB in the region, but epidemiologists estimated that 1 million more had TB but were neither diagnosed nor treated.

The scope and intensity of the global TB epidemic is fueled by antiquated and inadequate TB drugs, most of which were developed more than 50 years ago. But, given how contagious TB is, we need to find and treat many more people. It is a disease that strikes impoverished communities the hardest, and those same communities can be hard to reach with healthcare services.

And then came COVID-19, the only infectious disease that killed more people than TB in 2020. The regional numbers have held steady this past year, according to the World Health Organization, but a deeper dive shows that more attention is needed.

Dr.Morounfolu (Folu) Olugbosi

In Nigeria, my home country and Africa’s largest country by population, nearly three out of every four cases of TB were missed. Ethiopia, Africa’s second largest country, fared better, missing less than one out of every three cases. Kenya, a hub for international development in East Africa, missed almost half its TB cases. South Africa—where I work and which has one of the heaviest burdens in the world of drug-resistant TB infections, TB/HIV co-infections, and all TB infections in total—missed 40% of its cases in 2020.

Earlier this year, researchers analyzed how public health resources previously dedicated to addressing TB were allocated instead to handling the COVID-19 pandemic. The drop in cases of TB that were reported and treated at that time indicated that many more infections were slipping through the cracks of the world’s badly overstressed healthcare system. The researchers concluded that COVID-19 cancelled out the last 12 years of advancements in finding and treating people with TB.

Last month, a new report found that the number of people treated for TB in 2020 declined by 18%. Even more troubling, the number of people treated for the worst cases of drug-resistant TB strains declined by 37%–even with 41 countries in varying stages of evaluating and implementing a new regimen for these cases that my organization developed.

These diseases do not come at you in single file, patiently waiting their turn for a chance to wreak havoc. COVID-19 decimated the TB response because that response was weak and vulnerable. Now, we still have to handle another year of COVID-19 along with a resurgent TB

Like all strains of TB, drug-resistant TB can be easily spread by a cough or a sneeze—and it’s far more difficult to cure. In some regions, as many as 40% of new TB cases are drug resistant.

In 2018, the United Nations General Assembly held a high-level meeting on TB attended by more than 1,000 people—including the president of Nigeria and 14 other heads of state. At the meeting, pledges amounting to US$13.5 billion annually were made to help governments find and treat TB patients, with an additional US$2 billion pledged to boost the research and development efforts needed to develop new cures, and new ways of diagnosing infections. We are less than halfway to meeting these pledges, and as a result, TB has increased in strength in sub-Saharan Africa and other regions of the Global South.

As bleak as all this sounds, 2021 is on track to be much worse. Initial estimates from epidemiologists point to a lack of direct response to TB in projecting an escalation of missing TB cases. Even though both COVID-19 and TB are respiratory infections, TB lost whatever sunlight it may have once had.

There are some countries that have managed to keep moving forward though. Zambia, which missed one third of its estimated TB cases in 2020, may actually diagnose and treat a larger share of its TB caseload in 2021. But these success stories are few and far between. All too often, when the going gets tough, programs that tackle diseases of poverty fall by the wayside.

These diseases do not come at you in single file, patiently waiting their turn for a chance to wreak havoc. COVID-19 decimated the TB response because that response was weak and vulnerable. Now, we still have to handle another year of COVID-19 along with a resurgent TB.

It’s time to strengthen our resolve and tackle all of the diseases that afflict our most vulnerable communities—at the same time. TB has shown us that no one is safe if a contagious infection is thriving—regardless of whether we look for it or not.

Dr.Morounfolu (Folu) Olugbosi is the Senior Director, Clinical Development, TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.