Rebounding against TB: challenges and prospects
George NgenjaArticle Type:
Article Number: 7
The TB Thematic Update to the Strategy Committee
This article is based on an update to the Strategy Committee meeting in July. It discusses the intersection of COVID-19 and tuberculosis, highlighting setbacks and resilience in global TB efforts amidst the pandemic. It emphasizes the critical funding gaps, innovative strategies, and the need for stronger health systems. Using Nigeria as a case study, it illuminates the potential for significant improvements through strategic interventions. It also discusses the upcoming United Nations High-Level Meeting on TB and the role it could play in global pandemic preparedness.
Tuberculosis (TB), a disease that has plagued humanity for millennia, continues to pose a significant global health challenge. The Global Fund Strategy Committee’s recent meeting in early July underscored the urgency and complexity of this challenge, particularly in light of the ongoing COVID-19 pandemic’s disruption of TB services worldwide. However, the current findings also reveal promising progress, highlighting the potential for a more effective and resilient response to TB with increased funding, strengthened systems, and continued innovation.
In 2021, an estimated 10.6 million people worldwide had TB, a concerning 4.5% increase from 2020. This rise was largely attributable to the disruption caused by the COVID-19 pandemic which strained health systems worldwide and diverted critical resources away from TB services. The grim reality of this health crisis was further underscored by the sobering fact that 1.6 million people, including 187,000 HIV positive individuals, died from TB in the same year.
A success story illustrated by Nigeria’s TB response
The COVID-19 pandemic, as devastating as it has been, has also provided opportunities for innovation and adaptation in the global response to TB. The Global Fund’s COVID-19 Response Mechanism (C19RM) has played a crucial role in this regard, enabling more than $400 million in additional investment to support TB services and health system strengthening. In addition, the Global Fund has spearheaded efforts to scale up new tools and innovations, offering a promising pipeline of new products and approaches that are poised to make a significant impact in the coming years.
Figure 1. Country example: sharp increase in TB case notifications in Nigeria
Source: National TB Program, Nigeria
Nigeria’s experience in combating TB provides a compelling illustration of the power of these efforts. In just two years, from 2020 to 2022, Nigeria achieved a significant 37% increase in TB case notifications – a rise from 138,000 in 2020 to an impressive 285,000 in 2022. This trend, while undoubtedly promising, is not the result of mere chance or happenstance. Rather, it is a testament to the power of targeted investment and strategic interventions, including community case finding, public-private mix (PPM) strategies, service expansion, and the expansion of diagnostic networks. Furthermore, Nigeria has made tremendous strides in scaling up TB preventive therapy (TPT), with a sharp increase of over 500% from 2021 to 2022, further underscoring the impact of these efforts.
Funding gaps threaten progress in TB
Despite these promising developments, there is no room for complacency. Preliminary data from 2022 show a welcome rebound from the COVID-19 disruption, but they also highlight a significant funding gap that threatens to derail progress towards the global ‘End TB’ targets. Initial reviews of the Global Fund’s Window 1 Funding Requests have revealed significant gaps, particularly in the procurement of essential commodities like diagnostics. Despite the additional investments made possible by C19RM, the funding shortfall for TB programs remains a daunting $500 million.
The ramifications of this funding gap are far-reaching. As the Global Fund Strategy Committee meeting highlighted, the global shortage of TB drugs and diagnostics is a pressing concern that threatens to undermine progress against TB. Without a reliable supply of these essential commodities, millions of people in need are at risk of missing out on life-saving treatment. The current situation underscores the urgent need for more robust, diverse, and resilient supply chains to ensure the availability and accessibility of TB drugs and diagnostics for all who need them.
The United Nations will hold a high-level meeting on TB in September 2023
As the world prepares for the upcoming United Nations High-Level Meeting (UNHLM) on TB in September 2023, the urgency of these challenges cannot be overstated. The Global Fund Strategy Committee urges all stakeholders to seize the opportunities provided by these platforms to foster greater integration of efforts. The task at hand is not only to end the major pandemics of today, like TB, but also to enhance pandemic preparedness, tackle antimicrobial resistance, and make meaningful progress towards universal health coverage.
The key messages for the UNHLM include a call for increased funding for TB programs, greater domestic funding, investment in innovative financing mechanisms, and a concerted effort to scale up equity and access to innovations. These measures, the Committee contends, are essential to accelerating global progress towards ending TB.
The COVID-19 pandemic, while presenting unprecedented challenges to global health, has also shown the resilience and adaptability of the global TB community. Faced with adversity, health systems and communities worldwide have demonstrated that progress is not only possible but achievable with commitment, innovation, and strategic investment. As we navigate the complexities of the present and prepare for the uncertainties of the future, it is incumbent upon us to redouble our efforts and renew our commitment to ending TB. The lessons learned, and the progress made, serve as beacons of hope that we can indeed turn the tide against TB, forge a more robust defense against the pandemics of today, and build more resilient health systems capable of tackling those of tomorrow.
Constituency Feedback on TB Thematic Update
The recent TB Thematic Update generated significant feedback.
Some constituencies praised the significant progress made in TB diagnosis and treatment in 2022, commending the COVID-19 mitigation plans and the scale-up of case detection activities. Acknowledging the crucial role of community-based models in increasing case finding, people advocated for more investment in these models to reach underserved populations and overcome access barriers. They also supported the wider adoption of new TB care tools and technologies and the integration of TB control within broader health agendas.
Some stakeholders, recognizing the severe impact of COVID-19 on TB programs, highlighted the innovations and adaptability shown by these initiatives. However, they identified underfunding as the principal challenge facing TB programs and emphasized the urgent need for closing funding gaps in essential services such as TB diagnosis and treatment.
People expressed concern over the persistent underfunding of TB and emerging gaps in core TB programming. They emphasized the critical need for scaling up innovations in TB diagnosis, treatment, prevention, and targeted programming for childhood TB. In light of the upcoming United Nations High-Level Meeting on Tuberculosis, they called for increased effort from the Global Fund partnership at all levels to foster action, build political support, and channel resources for a sustainable TB response.
Finally, stakeholders commended the Global Fund Secretariat and partners for the informative update, particularly for the achievements and plans laid out. They noted the substantial gap in funding for diagnostic commodities and an overall deficit in TB funding, but they encouraged continued collaboration with partners and maintained support for the ongoing initiatives.