There will be a debate on estimates relating to the department for Education in the House of Commons chamber on 6 July 2022. This debate will be led by Robert Halfon MP.
Prior to the Covid-19 pandemic, tuberculosis (TB) was the leading cause of death from an infectious disease worldwide. Whilst international action is reducing the mortality and incidence of TB, leading health organisations such as the World Health Organization (WHO) have expressed concerns that more investment and action is needed to meet the milestones of the UN Sustainable Development Goals and the WHO End TB Strategy targets. These include a reduction in the incidence of TB by 50% by 2025, and 90% by 2035 (compared with 2015).
The most recent Global Tuberculosis report, published by the WHO in 2021, notes that the Covid-19 pandemic has reversed progress made in providing services for TB, and reducing the TB disease burden. It reports that “global TB targets are mostly off-track.”
World TB day 2022 is on 24 March, the theme is “Invest to End TB. Save Lives.” The WHO has said the theme conveys the “urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders”. The following sources provide more information about World TB day:
- WHO, On World TB day WHO calls for increased investments into TB services and research, 21 March 2022
- The Global Fund, Global Fund Calls for Renewed Urgency in Fight to End TB, 22 March 2022
Tuberculosis is a bacterial infection that most commonly affects the lungs. It is thought that one quarter of the world population have latent TB (this means that a person has become infected but has not become symptomatic). Of this group, an estimated 5-15% will go on to develop active TB in which they will display symptoms. Those with a compromised immune system such as people with HIV, diabetes, malnutrition and smokers are more likely to go on to develop active disease. TB occurs all over the world but the World Health Organisation reports that over 95% of cases and deaths are in developing countries.
The WHO reports that in 2020, an estimated 10 million people fell ill with TB, including 1.1 million children. There were around 1.5 million deaths from TB, including 214,000 among HIV-positive people.
The 30 high TB burden countries accounted for 86-90% of new TB cases. India, China, Indonesia and the Philippines have the highest numbers of cases.
TB is a treatable condition in almost all cases but requires six months of treatment with four antimicrobial drugs. This requires ongoing support, advice and information to ensure adherence.
TB that is resistant to the antimicrobial drugs used to treat the condition is an increasing concern. This has emerged through inappropriate or incorrect treatment of the infection and person to person transmission. It is estimated that half a million people annually have disease that is resistant to the most effective antimicrobials used to treat it. Multi-drug resistant TB is difficult and expensive to treat and the effective medicines are not always available. It is estimated that extensively drug-resistant TB (where the disease is resistant to at least four of the drugs that were once effective) has now been reported in 117 countries.
The only licenced vaccine for TB is the Bacillus Calmette–Guérin (BCG) vaccine, is widely offered to children through vaccination programmes, and provides moderate protection against severe forms of TB in infants and young children (such as TB meningitis). It is less effective against TB affecting the lungs in adults.
The following sources provide further information on TB:
- WHO factsheet on TB
- Tuberculosis: Multidrug-resistant tuberculosis (MDR-TB)
- The Global Fund, Tuberculosis
Global action on TB
The WHO leads on worldwide action on TB. Its 2015 End TB Strategy includes a number of milestones including a reduction in the incidence of TB by 50% by 2025, and 90% by 2035 (compared with 2015).
The UN Sustainable Development Goals (SDGs) also include a target for Member States to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases by 2030.”
In September 2018, the UN held the first High level Meeting on TB where a political declaration was agreed by all Member States. This recommitted to existing targets for TB in the SDGs and the End TB strategy and added further global targets:
- treat 40 million people for TB disease in the 5-year period 2018–2022;
- reach at least 30 million people with TB preventive treatment for a latent TB infection in the 5-year period 2018–2022;
- mobilize at least US$ 13 billion annually for universal access to TB diagnosis, treatment and care by 2022;
- mobilize at least US$ 2 billion annually for TB research
The next United Nations High-Level Meeting on TB will be held in 2023.
The 2021 WHO Global Tuberculosis report states that the Covid-19 pandemic has had a significant detrimental impact on progress towards targets on TB in 2020 and that this impact is likely to be worse in 2021 and 2022. It states that in 2020 “more people died from TB, with far fewer people being diagnosed and treated or provided with TB preventive treatment compared with 2019, and overall spending on essential TB services falling.”
In response to the findings of the report, Dr Tedros Adhanom Ghebreyesus, WHO Director-General said that it “must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.”
The report calls for urgent action to “mitigate and reverse” the impact of the Covid-19 pandemic. It states that the “immediate priority is to restore access to and provision of essential TB services such that levels of TB case detection and treatment can recover to at least 2019 levels.”
UK Government response
The UK Government invests in global action on TB primarily through the Global Fund to fight AIDS, Tuberculosis and Malaria. This is a partnership organisation between Governments, private sector and others to tackle disease. It raises funds and invests in local programmes in countries and communities most affected by AIDS, TB and malaria.
In February 2022, the Global Fund opened its Seventh Replenishment campaign, with an aim of raising at least $18 billion. It reports that the largest increase in funding need is for TB care.
A February 2022 Parliamentary Question response from the Minister of State at the Foreign, Commonwealth and Development Office, Amanda Milling provided information on the UK Government’s investment in the Global Fund, and commitment to the SDGs:
The UK is committed to achieving the Sustainable Development Goals including ending the HIV, tuberculosis and malaria pandemics by 2030. The UK pledged £1.4 billion in the 6th replenishment (2020-2022) to the Global Fund to Fight AIDS, Tuberculosis and Malaria, making us the 2nd largest donor towards the 6th replenishment and 3rd largest donor since the Global Fund’s creation. We are on track to fulfil our 6th replenishment pledge. Our health investments help countries to build stronger and more inclusive health systems to address all causes of ill health. We also invest in research and innovation to help people access new treatments and diagnostics, and support countries affected by these diseases to strengthen their health systems.
The UK Health Security Agency (UKHSA) published the Tuberculosis (TB): action plan for England in July 2021. It aims to “improve the prevention, detection and control of TB in England.” The TB action plan includes measures to ensure a continued reduction in TB incidence and transmission in the UK, to enable the UK to meet its commitment to global elimination targets. The plan has five priority areas:
- Recovery from COVID-19- It is expected that missed and delayed diagnoses, late presentation of symptoms and delayed treatment will have increased the pool of undetected and unreportedTB in the community, potentially leading to and increase in TB cases in the short term.
- PreventTB- Prevent and protect susceptible people in England from acquiring TB infection and developing active disease. This will include increasing latent tuberculosis infection testing (where groups at risk of TB are screened to see if they are carrying the bacteria without displaying symptoms) and offering the BCG vaccine to all those eligible within 4 weeks of birth.
- DetectTB- Improve early detection of TB by identifying, investigating and acting on the components that contribute to patient delay.
- ControlTB disease- Prepare and respond to emerging threats from TB transmission clusters, outbreaks and incidents and drug resistant This will include the rollout of the new National TB Surveillance System and the routine provision of whole genome sequencing data to TB services to allow them to better understand how the infection is being transmitted in the local community.
- Workforce- Develop and maintain the healthcare workforce to ensure workforce capacity to detect, case manage and control
The Global fund, Global Fund Calls for Renewed Urgency in Fight to End TB, 22 March 2022
WHO, Factsheet: Tuberculosis, October 2021
WHO, Global Tuberculosis report, October 2021
Global Fund to fight AIDS, Tuberculosis and Malaria: Seventh Replenishment Investment Case 2022
UKHSA, UKHSA launches long term action plan to reduce tuberculosis in England, July 2021
UKHSA, Tuberculosis (TB): action plan for England, July 2021
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