Evolution of tuberculosis in Spain: Will the objectives of the End TB Strategy be achieved in Western European countries?

Objectives End TB Strategy aims to reduce the incidence of tuberculosis between 2015 and 2025 milestone by 50%. We analyse whether the decreasing incidence objectives of this strategy can be achieved in Spain with the impact of COVID-19 pandemic and to review the incidence evolution in Western European countries (WEC). Study design Retrospective longitudinal ecological study with forecasting. Methodology An exponential curve was fitted to the Spanish and WEC data prior the pandemic period and projected with the model until 2025 using a 90% confidence interval to have better precision due to the sample size. Results The mean annual % change in incidence rates of TB in the three most affected WEC during 2018-2022 decreased by 6.5% in Spain, by 6.0% in Portugal, by 3.8% in Belgium and by 5.7% in France. The annual decrease in Spain in the first year of COVID-19 pandemic was 16.6%. Lower declines than in Spain were observed in most WEC. The probability of achieving the objective of reducing the incidence by 50% between 2015 and 2025 in Spain is, with a certainty of 90%, 0%, but with important differences by regions from 0% to 79%. These probabilities in Portugal, Belgium, France and Italy are also 0%. Conclusion With this epidemiological evolution, the main objective of the End TB Strategy for 2025 milestone (50% incidence decline) will not be achieved in Spain. The 80% decline will probably not be reached by 2030 unless surveillance and control are improved, and TB Programmes are provided with sufficient resources. The same situation could be happening in other WEC.