Is Covid-19 derailing the fight against TB?

In 2020, the Global Fund investments dropped by a staggering 19 per cent. The same year, the number of people treated for drug-resistant TB in 140 countries dropped by 37 per cent. Representation pic

With tuberculosis (TB) cases rising once again, health experts are worried about the drop in international funding that India was earlier receiving for conducting various tuberculosis programmes to contain the epidemic. The decline in funding amid the Covid-19 outbreak in the past two years has adversely affected TB-DOTS (Directly observed treatment, short-course) programme, say experts. "India was receiving approximately 200 million dollars (Rs 1,500 crore approximately) per year from global agencies to contain tuberculosis.

However, after the outbreak of Covid, it has slackened both in terms of funding and implementation of anti-tuberculosis programmes on the ground, in India. This figure is approximately 20-25 per cent of the total annual expenditure incurred by the health ministry. The health ministry has chipped in by providing local funds to bridge the deficit," said Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle, and advisor to WHO-TDR-Geneva.

mid-day, in its report dated February 9, titled ‘Post-Covid, patients focus should be on boosting immunity' had highlighted how low immunity increased the risk of contracting tuberculosis and other infectious diseases.

Global impact on TB control programmes

"In 2015-16, when Ebola struck several West African countries including Sierra Leone, Liberia, DR Congo, Nigeria among others, the accomplishments of the Global Fund over 15 years in controlling tuberculosis, HIV/AIDS, and malaria were almost wiped out. The 2020 numbers confirm that 4.7 million people treated for TB was an 18 per cent decrease in treatment rate compared to 2019. This was due to the Covid pandemic. The Results Report of GFATM-Geneva, which has a global budget of US$15 billion over a three-year cycle and provides 77% of global TB funding, has revealed the catastrophic impact the Covid pandemic has had on the fight against TB worldwide," said Dr Hira.

He added, "In 2020, the Global Fund investments dropped by a staggering 19 per cent. The same year, the number of people treated for drug-resistant TB in 140 countries dropped by 37 per cent."

Covid recovered patients must undergo a TB skin test

Dr Hira said, "In the rush of the Covid pandemic and its waves, the medical fraternity has been observing a sudden increase in the number of active cases of TB that has emerged as an opportunistic infection to Covid. India has 360 million people with latent TB. But when people suffer from active Covid, the immune suppression causes activation of latent or dormant TB. Hence, post-Covid patients should undergo a TB skin test four-six weeks after the acute episode, because the virus is likely to cause immune suppression and lead to reactivation of dormant TB."

‘Millions of people have undiagnosed TB Globally'

Dr Wiqar Shaikh, Professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals said that currently 4.1 million people globally have undiagnosed TB, mainly because their ailment has not been reported to their respective governments. India, he said, has been the country that has reported the highest reduction in TB cases, the tally being 41% compared to the previous year. He said, there has been a reported fall in global spending from US 5.8 billion dollars to 5.3 billion dollars which is less than half of the global target of 13 billion dollars in 2022.

Dr Shaikh quoting the WHO said approximately 85% of people who develop TB can be successfully treated with a six-month drug regimen. He said in India, overall there are 2.6 million TB cases in our country and 1.24 lakh cases have Multi-Drug Resistant (MDR) TB, which is approximately 9.1% of the total TB cases. The total number of deaths due to TB in 2018 was 4.45 lakh, as per WHO.

‘Low immunity poses risk'

"Many patients suffering from low immunity after Covid are at a greater risk of getting TB infection. The Global Fund provides almost 77% of international finance for TB which is used in the treatment and prevention of TB. This funding is a key factor in the TB eradication program,me" said Dr Santosh Bansode, Head of the Department, Emergency Medicine, Wockhardt hospitals, Mumbai Central. "Many TB patients are from low socio-economic groups who get benefit in TB treatment because of such funding. Since now Covid is getting under control, we are hoping that global funding should once again begin for eradication of TB," he said.