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World TB Day 2021: As We Make Progress Against COVID-19, We Must Not Lose More Ground Against Tuberculosis

While COVID-19 has taken the place of tuberculosis as the world’s leading infectious disease killer, on this World TB Day the ancient disease remains our oldest and most neglected epidemic despite being preventable and curable. Over 10 million people developed active TB disease in 2019, while 1.5 million people died from the disease. Tuberculosis continues to be the leading killer of people living with HIV and remains a driver of antimicrobial resistance globally, with over 558,000 cases of multidrug-resistant TB reported in 2018. One-third of all AMR-related deaths globally are from drug-resistant forms of TB.

The COVID-19 pandemic has thrown the global response to TB into a crisis, with disruptions to lifesaving TB services undoing years of progress. Underdeveloped and poorly resourced public health infrastructure — including in the U.S. — has forced many countries to divert TB resources, personnel and programming, including case finding and contact tracing activities, to respond to COVID-19. As a result, the overall number of people diagnosed and treated for TB in the highest-burden countries has been set back to 2008 levels.

In addition, emerging research from India and South Africa finds that people coinfected with TB and COVID-19 are three times more likely to die than people infected with TB alone, highlighting the urgent need to scale up bidirectional TB and COVID-19 testing, contact tracing and TB treatment initiation in high-burden countries.

The rapid development of diagnostics, vaccines and therapeutics against COVID-19 is a testament to how quickly and effectively the world can respond to a public health crisis if appropriately resourced. In comparison, existing tools against TB are antiquated, slow and becoming increasingly ineffective. The most commonly used TB treatment regimen was developed decades ago, and the only vaccine against TB in existence — developed almost 100 years ago — is only partially effective in infants. Research and development of more affordable rapid diagnostics, shorter treatment regimens and new and effective vaccines for children and adults is urgently needed to meet global TB elimination goals.

A setback of 12 years in efforts to eliminate TB as a global public health threat will have impacts for years to come unless we act now to protect the gains we’ve made. Renewed U.S. leadership is urgently needed to address the COVID-19 pandemic’s impacts on the TB epidemic, including more resources for the U.S. Agency for International Development and CDC programs that fight TB here at home and globally. Congress must act to pass vital legislation to give federal agencies the resources they need to accelerate progress, including passage of the Comprehensive TB Elimination Act. Without urgent action, TB will remain a threat to global public health for decades to come.

IDSA and colleagues from the TB Roundtable — a coalition of organizations dedicated to TB control in the U.S. and globally — hosted a virtual Congressional briefing on the COVID-19 pandemic’s impacts on global TB control efforts, featuring presentations from leaders at the World Health Organization and USAID, IDSA members and TB treatment and research and development advocates. The briefing was organized in cooperation with the Congressional TB Elimination Caucus, co-chaired by Reps. Ami Bera and Don Young, and by Sen. Sherrod Brown, who shared this video message for World TB Day. A recording of the briefing is available online.

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