Tuberculosis deaths rise for the first time in more than a decade, reveals a global report
Increase in deaths was due to the interruption of access to services to tackle tuberculosis and the reduction of resources09/11/2021
The World Health Organization (WHO) declared in mid-October that deaths from tuberculosis, one of the worlds top killer infectious diseases, rose for the first time in the decade as a direct result of the pandemic. The new data demonstrates how years of progress in preventing the disease has been reversed since the pandemic overwhelmed health systems in 2020, preventing people from seeking medical help. The WHO Global Tuberculosis Report 2021 showed that lockdowns around the world made difficult access to health services for a good part of the population. According to the organization, the death rate from the disease could be even higher in 2021 and 2022. The document presents data on disease trends and response to the epidemic from 197 countries and areas, including 182 of the 194 WHO Member States.
According to the document, about 1.5 million people died from the disease in 2020, more than in 2019, after analyzing the epidemic response in 197 countries and regions. Also according to the report, around 1.5 million people died of tuberculosis in 2020, a number that had not been reached since 2017, including 214 thousand among HIV-positive people (compared to 209 thousand in 2019) and 1.3 million tuberculosis deaths among other patients (compared to 1,2 million in 2019). In the same year, Brazil recorded 66,819 new tuberculosis cases and was the second country with more cases in the world.
The president of the Brazilian Network for Research on Tuberculosis REDE-TB, Dr. Ethel Maciel, regrets the data pointed out in the report, which demonstrate how significant the impact of the pandemic was on tuberculosis indicators, as well as the impacts related to the decrease in access to services of health, reduction of consultations, of diagnostic exams. Furthermore, due to the pandemic, there was also an increase in poverty in the world, especially in countries that have the highest burden of the disease, and which are developing countries, which still suffer from problems of social inequality, she points out, recalling that tuberculosis, being a disease related to poverty, is directly related to these economic indicators.
The increase in the number of deaths occurred mainly in the 30 countries with the highest burden of the disease. Countries with the highest number include India, China, Indonesia, Philippines, Nigeria, Bangladesh and South Africa. According to the document, the number of new diagnoses fell from 7.1 million in 2019, to 5.8 million in 2020. This means that fewer people were diagnosed, treated or received preventive treatment for tuberculosis in 2020. The main drops in notifications of the disease between 2019 and 2020 occurred in India (41%), Indonesia (14%), the Philippines (12%) and China (8%). The UN health agency also highlighted that these and 12 other countries accounted for 93% of the total decrease in notifications globally. WHO estimates that around 4.1 million people currently suffer from tuberculosis but have not been diagnosed or have not officially reported to authorities. This number is far greater than the 2.9 million in 2019.
Spending on essential services for tuberculosis fell, as well as on preventive treatment for the disease. The report reveals that about 2.8 million people had access to preventive care in 2020, a reduction of 21% compared to 2019. In addition, the number of treated patients who are drug resistant decreased 15%, from 177 in 2019, to 150 in 2020, equivalent to one in three of those in need. The drop in reported cases is mainly seen in India, Indonesia, the Philippines and China. Global spending on TB diagnosis, treatment and prevention has fallen from $5.8 billion to $5.3 billion in 2020, less than half of the global funding target, set at $13 billion a year by 2022. According to Dr. Maciel, an epidemiologist and professor at the Federal University of Espírito Santo (UFEs), the pandemic brought this double burden to tuberculosis, in addition to the impact on access and on the reduction of health services themselves, the problems related to economic issues, with a consequent decrease income, unemployment, which also end up influencing and impacting for these indicators to worsen.
But the report also points successes. Globally, the number of people who fall ill with TB each year (relative to the population) fell by 11% from 2015 to 2020, a little more than halfway to the 20% mark in 2020. However, the WHO European Region surpassed the 2020 mark with a 25% reduction. This was mainly due to the decline in the Russian Federation, where incidence fell by 6% a year between 2010 and 2020. The WHO African Region came close to reaching the milestone, with a 19%, reduction, which reflects impressive reductions of 4%-10% per year in South Africa and several other Southern African countries, following a peak in the HIV epidemic and the expansion of tuberculosis and HIV prevention and care.
Global tuberculosis targets were not met by 2020 and seem increasingly out of reach. Globally, the reduction in the number of tuberculosis deaths between 2015 and 2020 was 9.2% — about a quarter of the way to the 2020 mark of 35%. The report urges countries to implement urgent measures to restore access to essential tuberculosis services. In addition, it calls for a doubling of investments in TB research and innovation, as well as concerted action across the health sector and others to address the social, environmental and economic determinants of the disease and its consequences. For Dr. Maciel, it is urgently necessary to expand efforts so that tuberculosis is effectively a priority from the point of view of having greater financial support for the improvement of care, as well as the improvement of social protection for that population that most needs it.
Approximately 90% of people who fall ill with tuberculosis each year live in 30 countries, including Brazil. Most who develop the disease are adults. In 2020, men accounted for 56% of all cases, women accounted for 33% and children 11%. Many new cases of the disease are attributed to five risk factors: malnutrition, HIV infection, disorders related to alcohol use, smoking and diabetes. Tuberculosis is preventable and curable. About 85% of people who develop the disease can be successfully treated with a 6-month drug regimen; the treatment has the additional benefit of reducing the progressive transmission of the infection.