Biosocial Strategies to Address the Socioeconomic Determinants and Consequences of the TB and COVID-19 Pandemics

COVID-19 and tuberculosis (TB) are damaging, dual pandemics, which are more than mere health crises; they are socioeconomic and humanitarian crises that require a biosocial response. he socioeconomic determinants of TB and COVID-19 are pernicious and overlapping. Poverty, overcrowded housing conditions, under-or malnutrition, chronic comorbidities such as lung disease and diabetes, and belonging to marginalized, underserved communities and minority ethnic groups are all key determinants. 3 COVID-19 has distorted health systems at all levels. It has contracted clinical services, decimated staffing levels, reconfigured laboratories including the repurposing of GeneXpert modules for TB diagnosis, rolled back hard won progress toward Universal Health Coverage (UHC) and global health security, 4 and diverted much-needed resources away from other diseases, including TB. he health and socioeconomic consequences of TB and COVID-19 are highly harmful and inequitably distributed. mpoverished individuals, households, and communities continue to be disproportionately affected by both TB and COVID-19. Social distancing and isolation measures, restricted movement and quarantine, illness, and care-seeking impose a severe socioeconomic burden, especially on those who are unemployed, in the informal job sector, or lack adequate social protection. 1 These factors are not only associated with impaired healthcare access and worse health outcomes 9,10 ; they can push those affected into further impoverishment, typifying the "medical poverty trap." The corrosive influence of COVID-19 and its related mitigation strategies on mental health and domestic violence is a parallel, concomitant emergency. ar from being great "levellers," these intersecting pandemics have reemphasized intolerable and persistent global inequalities in health, wealth, and well-being-inequalities that are aggravated by poverty of voice, agency, and opportunity. However, the convergent challenges brought about by COVID-19 and TB enable us to identify potential opportunities to mitigate their impact.