The Impact of COVID-19 on Global Tuberculosis Control

Abstract RATIONALE Mycobacterium Tuberculosis (TB) was the leading cause of worldwide infectious mortality worldwide before the COVID-19 pandemic, responsible for 1.3 million deaths annually.1 Through international TB-related services and prevention efforts, mortality had been steadily decreasing for the preceding decade.1,3 In 2020, COVID-19 surpassed TB as the leading cause of infectious mortality worldwide. As COVID-19 overwhelmed international healthcare systems in 2020, financial resources were diverted, reversing years of progress in global TB control.1,3 Since the development and distribution of COVID-19 vaccinations, COVID-19 mortality has dropped significantly. However, global TB control efforts have fallen gravely behind. METHODS Global reports from World Health Organization (WHO) and Treatment Action Group were reviewed to assess temporal trends in mortality and funding for COVID-19 and TB. Data from the Organization for Economic Co-operation and Development and Institute for Health Metrics and Evaluation were used to create estimates of government funding for COVID-19 and TB from 2019-2023. RESULTS In 2020, COVID-19 surpassed TB mortality to reach 1.89 million deaths annually.2 During this time, there was a 25% reduction in newly diagnosed TB cases, and, for the first time in a decade, tuberculosis mortality increased. As government COVID-19 spending skyrocketed, federal TB funding plummeted, exacerbating already stark funding gaps between government TB spending and necessary target funding detailed in the WHO Global Plan to End TB 2023-2030 report (Table 1). According to the WHO, COVID-related disruptions resulted in almost 0.5 million excess deaths from TB 2020-2022, compared to the number that would have occurred if pre-pandemic trends were continued.4 Despite remarkable reductions in COVID mortality (COVID-19 mortality has dropped towards 100,000 deaths in 2023), federal TB funding trends have not recovered: 2023 government spending on TB remains lower than levels prior to the pandemic (Table 1), and TB has reclaimed its status as the leading infectious cause of death worldwide.1,2CONCLUSIONS As international focus shifted toward COVID-19 control and away from TB agendas, the global community fell behind its projected global TB funding and mortality targets. Reduced TB reporting with subsequent increased transmission and mortality can be partially attributed to diversion of critical TB resources. The ongoing lag in domestic TB funding underscores the need for federal governments to re-orient themselves towards TB eradication efforts and recover progress lost during the COVID-19 pandemic. In the absence of drastic reconstruction of TB initiatives, the goal of eradicating TB in the coming decade remains aspirational at best.