The COVID-19 pandemic has reshaped many aspects of global health, with far-reaching consequences that extend beyond the acute crisis itself. A recent analysis reveals the significant, lingering impact on tuberculosis (TB) in the United States, where the pandemic has resulted in a troubling increase in TB cases and related deaths. According to CIDRAP, researchers estimate that from 2020 to 2035, there could be nearly 3,000 additional TB cases and over 1,100 deaths linked directly to changes experienced during the pandemic. This marks a dramatic shift for a disease that had been progressively declining for years prior to 2020.
The team from Harvard University identified four mechanisms contributing to these concerning trends: immigration, respiratory contact rates, rates of accurate diagnoses and treatment initiation, and mortality among TB patients. The research utilized a Bayesian approach to combine evidence from the pandemic, simulating a hypothetical situation without the pandemic, where previous patterns would have continued. It’s troubling that while contact rates fell, it ironically led to increased TB deaths as fewer people were diagnosed and treated effectively.
The Current TB Landscape
The pandemic has set back TB progress significantly. Highlighting the global scenario, PMC notes that TB was once the leading cause of death from a single infectious agent, but in 2020, reported cases dropped by 18% compared to 2019. This decline only partially recovered in 2021, with an estimated 10.6 million people falling ill that year—a 4.5% increase from 2020. This surge reversed years of positive trends in TB control and elimination.
Globally, TB deaths rose from 1.4 million in 2019 to 1.6 million in 2021, illustrating the pandemic’s heavy toll. Countries like India, Indonesia, and the Philippines witnessed the sharpest declines during the pandemic, only to face the largest rebounds in TB cases as healthcare systems struggled to manage both TB and COVID-19. The World Health Organization (WHO) emphasized this challenge in their Global Tuberculosis Report 2022, stating that progress in TB elimination is not just stalled but, in many areas, actually reversed.
Unmasking the Underlying Issues
Difficulty in accessing essential TB diagnosis and treatment services has compounded the issue. Health systems worldwide faced unprecedented pressures during the pandemic, causing delays and under-reporting, as detailed in the WHO report. There was a dramatic gap between estimated and reported cases, contributing to a greater risk of contagion and subsequently worsening the TB burden globally. By 2021, the cumulative total of diagnosed TB cases across several years only met 66% of the WHO’s five-year target.
Furthermore, preventive treatments for individuals living with HIV increased, but vaccination coverage for TB dropped slightly from 88% in 2019 to 84% in 2021. With only $5.4 billion allocated for TB globally in 2021—about half of what is needed—it’s clear that the focus on COVID-19 vastly overshadowed continuing public health efforts against TB, risking lives and public health worldwide.
In the face of ongoing health challenges and the long-standing presence of TB, experts argue for urgent increased funding and targeted strategies to address the gap in TB diagnostics and treatment caused by the pandemic. As we edge into the future, it is more than crucial that we bring TB back into focus to met critical global health goals, as illustrated by the WHO’s ongoing recommendations.
The need for a comprehensive response could not be clearer—it’s high time to address these challenges head-on, ensuring both immediate and long-term health strategies that protect against the dual threats of TB and future pandemics.