Global Push to Combat Tuberculosis Amid COVID-19 Setbacks, Australia

Queensland (Aus), Feb 20 (360info) Tuberculosis is the world’s most deadly infectious disease. But lofty global plans to stamp out this global killer by 2030 were dramatically slowed by the COVID-19 pandemic. When COVID struck, the world swiftly responded, pouring unimaginable amounts of money into the development of new drugs and vaccines. In stark contrast, tuberculosis (TB) has persisted for centuries, yet many people in the developed world remain largely unaware of it, and vaccine development has received little attention. A new push for action, brought on by rising case numbers around the world, could finally make a difference in the fight against TB — but only if that commitment is sustained. In 2021, global deaths from TB increased for the first time in almost a decade: the disease claimed 1.5 million lives that year, up from 1.4 million in 2020 and 1.2 million in 2019. Lockdowns, disruptions in healthcare, and the redirection of resources hampered active case finding, diagnosis and treatment, reversing gains made in recent years. Some experts believe that COVID-19 has reversed two decades of progress in the fight against TB — a significant setback from which it will take at least five years to recover. TB is a preventable and usually curable disease. But it remains staggeringly widespread: almost one-quarter (23 percent) of the world’s population is infected with the TB bacteria. Many latently infected with TB are unaware they have the disease, as they don’t experience symptoms, which include cough, fever, fatigue and weight loss. But for some, it’s deadly: over the last two centuries, TB has claimed more than a billion lives. The campaign to eradicate TB gained further momentum in 2014 when the WHO launched the post-2015 End TB Strategy in support of the Sustainable Development Goals. The aim was ambitious: a 95 per cent reduction in TB deaths by 2035. The strategy called for new treatments, improved diagnostics, increased research investment, universal health coverage and, importantly, an effective vaccine. TB deaths declined again in 2022 and 2023 — indicating that post-COVID, the fight against TB was back on in earnest — but the setbacks of 2020 and 2021 have taken a toll. If the current trajectory persists until 2050, it is estimated that TB could bring more than 27 million deaths and economic losses exceeding USD$13 trillion. First, the bacterium causing TB, Mtb, has developed sophisticated defences to evade the immune response, allowing it to remain dormant within the human body, particularly the lungs, for decades. About 90 percent of infected people will never develop active disease. This is known as latent TB infection (or LTBI), and it makes TB even more challenging to diagnose and treat. As well as being complex, TB diagnosis is also not always accurate. Treating TB involves six to 12 months of antibiotic therapy. This poses a substantial financial strain on healthcare services, especially in developing nations, as well as on patients in countries where out-of-pocket costs are involved. Drug resistance is an alarming obstacle to TB prevention and treatment, making treatment of the disease harder and longer. Treatment of multidrug-resistant TB (MDR-TB) is complicated. It can take up to two years and requires hospitalization. Extensive and totally drug-resistant Mtb strains have also been reported, highlighting the magnitude of drug resistance in TB infections. Research on TB is slow and logistically challenging compared with other infectious agents. In today’s fast-paced and output-driven academic environment, only a handful of scientists are willing to make TB their primary research focus. As of January 2024, there were only 17 TB vaccine candidates listed in the active clinical trial pipeline. In September 2023, at the second United Nations high-level meeting on TB, world leaders adopted a declaration for a renewed pledge to end the TB epidemic. The world committed to provide USD$5 billion of annual funding for TB research by 2027. If honoured, this financial support may offer real hope, reignit…