COVID derailed tuberculosis progress and urgent action is needed

On World TB Day 2023, Burnet Institute Director and CEO Professor Brendan Crabb AC and Results Australia CEO Negaya Chorley draw on lessons from the global COVID-19 response and how they could be applied to defeat tuberculosis in this editorial for The Canberra Times, reproduced here with permission.

While the response to the COVID-19 pandemic was in some ways miraculous, the disruption to other healthcare services was immense, and it especially derailed global progress in combating tuberculosis.

Infections have gone undetected and unmanaged. As a result, for the first time in more than a decade, tuberculosis deaths are rising.

Some 1.6 million people died from tuberculosis in 2021 and it’s now claiming 4,300 lives a day, including the lives of 600 children.

So why aren’t we all worried? Possibly because tuberculosis disproportionately affects vulnerable populations, including in Australia.

In early March this year, health authorities declared a tuberculosis outbreak in the APY Lands, after 10 cases were diagnosed.

While tuberculosis infection rates in Australia are among the lowest in the world, incidence is several times higher for Aboriginal and Torres Strait Islanders compared to our non-Indigenous population.

Modelling suggests tuberculosis pre-elimination in the Top End likely won’t be reached until about 2066.

Our closest neighbour, Papua New Guinea, is also a tuberculosis hotspot. The WHO estimates 42,000 people in Papua New Guinea contracted tuberculosis in 2021. More than 5,400 people died.

Like COVID-19, tuberculosis' deadliness cannot be stopped without a new vaccine. Yet the only tuberculosis vaccine we have is more than a century old. The BCG vaccine protects infants and young children more effectively than adolescents and adults. That’s a problem given that adults account for the bulk of the disease burden.

Investment in tuberculosis vaccine research has stagnated since 2019. The gap between what’s needed and what’s available is significant. Just US$120 million was spent on tuberculosis vaccine research and development in 2021 - a small fraction of the global spend on COVID-19 vaccines, and well short of the Global Plan to End tuberculosis' annual target of US$1.25 billion.

Investing in vaccines is not just the right thing to do, it also makes good economic sense. The WHO estimates every US$1 invested in vaccine interventions will return US$7 in health and economic benefits over 25 years.

But vaccines alone won’t solve the problem. We need a comprehensive approach to tuberculosis that sees us using all the tools at our disposal. We need to scale up existing and new treatments, roll out widespread screening in high burden countries, and ensure people with active tuberculosis infection have rapid access to treatment.

So what can Australia do?

COVID-19 has shown us what’s possible when the world comes together to tackle a shared problem - and when it comes to tackling tuberculosis, it’s crunch time.

In September this year, political leaders will gather in New York for the UN High-Level Meeting on tuberculosis. Given Australia’s proximity to countries heavily impacted by tuberculosis, and the cutting-edge tuberculosis research that takes place in universities and research institutions across Australia, we are uniquely positioned to play a lead role.

Australia can and must encourage world leaders to set ambitious targets for tuberculosis elimination and back the targets up with proportionate financing for research and development and tuberculosis vaccines, screening, treatment and programs.

If financing stays at current levels, the Global Plan to End tuberculosis 2023-30 estimates that over the next eight years an additional 6.6 million people will die from tuberculosis and $US1 trillion will be wiped off the global economy.

We learned many lessons from the COVID-19 pandemic. A key one was an acute reminder of the breakthrough power of science to solve seemingly impossible problems - a vaccine in a year was previously unthinkable for example.

This way of thinking and approach needs to be applied to scourges that have dogged humanity for centuries, and top of that list is tuberculosis. We can defeat tuberculosis, but we need the will to do it.

Click here to read the original article in The Canberra Times.