Ahead of this year’s World Tuberculosis (TB) Day, marked on 24 March, the Stop TB Partnership called for an urgent and substantial increase of funding to fight TB in order to meet the goal of ending the disease by 2030. The organization’s latest projections show that an average of US$19.6 billion per year will be needed over the next eight years for TB prevention and care, up from the pre-COVID-19 estimate of US$13 billion per year. An additional US$4 billion per year will be required for research and development (R&D) of the new diagnostics, medicines and vaccines needed to end TB. This represents about four times what is currently available for the TB response (in 2020, US$5.3 billion was available for care and prevention and US$0.9 billion for R&D).
The year 2022 is critical for the global fight to end TB as the world faces a fast-running countdown to reaching the 2018 United Nations High-Level Meeting (UNHLM) TB targets, which the international community agreed to meet by the end of December. All projections show that the world is not on course to meet the UNHLM treatment targets set for 2022.
“We simply cannot continue to stand on the sidelines and watch while people around the world fall ill and die from a preventable and treatable disease,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership. “We also cannot continue to accept what we accepted for years—every year having less than 40% of the funding need for the TB response. Now we are facing a disastrous funding shortfall, bigger than what we had expected. We not only need to step up efforts to meet targets set at the 2018 UNHLM on TB, but the TB response must also recover from the devastating impacts of the COVID-19 pandemic.”
The projected increase in the funding needed to end TB considers setbacks caused by the COVID-19 pandemic and related recovery measures, as well as the impact of years of funding shortfalls. Such additional funding will enable TB programs around the world to treat 50 million people with TB, including 3.7 million children and 2.2 million people with drug-resistant TB. It will also enable faster R&D, including new and effective vaccines, which are essential if we want to end TB by 2030.
Reaching the joint goal of ending TB is feasible if countries step up their funding commitments. Countries of the G20, for example, who represent 50% of the global TB burden, had a collective GDP of US$66 trillion in 2020, which is projected at US$99 trillion in 2026. The Stop TB Partnership estimates that mobilizing only 0.01% of this collective GDP would make an additional US$6 billion available per year for the fight against TB now and US$10 billion per year by 2026.
“TB is an infectious and deadly airborne disease with drug-resistant variants, and it is in no one’s interest to continue to let it fester undeterred around the world. Each untreated TB infection can lead to 15 more infections per year. As we saw in 2020 with COVID-19, we can mobilize significant amounts of funding in a short time if people, including world leaders, take the disease seriously. We don’t demand anything out of the ordinary; we demand funds to secure access to proper diagnosis and treatment for all people. It is, after all, a basic human right,” Dr. Ditiu added.
TB in times of conflict
The new funding estimates come in the context of the ongoing brutal war in Ukraine, and experts expressed grave concern about the potentially devastating impacts on health services, including the TB response in the country and the region. Ukraine is one of the top 30 high drug-resistant TB burden countries in the world, with 1 in 3 people having a form of TB that does not respond to the most potent TB drugs. In 2021, Ukraine diagnosed and treated 24,000 people with TB, including almost 5,000 people with multi-drug resistant TB (MDR-TB).
“The ongoing war is completely unacceptable. We all make tremendous efforts to have a better, healthier world, and we celebrate every single person with TB treated with success and cured. And we see now lives being lost in hundreds in a blink. This must stop,” said Dr. Ditiu.
Ukraine has a strong national TB program, with its supply of TB drugs entirely financed from its domestic budget, diagnosis, and treatment available to all people in need nationwide and a well-organized civil society response. While information from the national TB program indicates that a majority of people with TB are still receiving the care they need, having been provided with at least a month’s supply of drugs, some have already been forced to discontinue treatment due to lack of access to health care facilities. The situation is volatile, and it is expected to worsen if more people are unable to renew their prescriptions in the coming months and if attacks on health workers and health facilities continue unabated.
“Whenever there is conflict or war, essential health services and care are disrupted, with devastating consequences for the health of affected populations, especially the most vulnerable,” added Dr. Ditiu. “While attending to people’s immediate and basic needs is the absolute priority, neglecting to act on TB now may have grave consequences in the near future. Interruption of treatment will lead to the further development of drug resistance, the movement of populations, the closeness experienced in shelters and on the roads, and the drop of immunity will naturally lead to an increase in infections.”
With the war resulting in unprecedented numbers of internally displaced people as well as refugees to neighboring countries, it is critical that TB services are provided to all those in need, free from stigma and discrimination.
“TB is very sensitive, and if we broadcast information about its uncontrolled spread, we will stigmatize people who are already stigmatized, for people who are already in a very difficult situation,” said Ms. Yana Terleeva, Head of Department of TB Programme Coordination, Center for Public Health of the Ministry of Health of Ukraine. “The issue of TB stigma is not only in Ukraine, but across Europe, so let’s focus on ensuring patients know where to go and have a desire to continue treatment. They have to be assured there is a reason to live, that they will go back to Ukraine, and they have to be healthy to help us rebuild. They need this optimism, to have this desire to live and continue living.”
“We urgently need to provide the support needed to ensure continuity of treatment for people affected by TB, as well as to equip neighboring countries with the tools they need for timely diagnosis and treatment of refugees,” said Dr. Nino Berdzuli, Director of the Division of Country Health Programmes, WHO.
The Stop TB Partnership is continuously monitoring and assessing the situation in Ukraine and is coordinating efforts with partners to provide seamless supplies of additional TB drugs to Ukraine if this need arises. They are also assuring that diagnostics and medicines are reaching the neighboring countries for uninterrupted TB care of people in need. The organization is also repurposing existing grants to support immediate emergency and lifesaving medical needs.
Ms. Iana Terleeva, Head of Department of TB Programme Coordination, Center for Public Health of the Ministry of Health of Ukraine
“Ukraine was always on the forefront of the fight against TB. We chose the European way of working when it comes to diagnostic and care. We wanted Ukraine to be free from TB. We have done everything possible. We commenced European reforms in this regard, put in place new policies on how to treat people with TB, and introduced new diagnostic methodologies. We’ve worked to overcome the stigma and discrimination that comes with TB. We thought in March that we’d be implementing innovative TB treatment regimens.
“Last year, we were working to differentiate between different TB mutations. Now instead, we are trying to differentiate between aerial shelling, raids and other military hardware. We are on the 26th day of the war and Ukraine has to fight on the one side illnesses like TB, and on the other side the Russian invasion.”
“Thousands of people are now without access to their homes or any sort of dwelling. They are deprived of their dreams and plans for the future. This has forced many of our patients to look for better opportunities, we see displaced people within the country, and some of our patients leave Ukraine to find better opportunities in other countries. We appeal for the exchange of information about these patients so we can treat them further. We are working with the WHO on creating a coordination center so we can exchange information so patients know where to continue treatment.
"We are defending our country from the aggression while at the same time providing everything necessary for our patients.”
Ms. Olya Klymenko, TB survivor and co-founder of the organization TB People Ukraine
“We understand quite clearly that when the war is over, we will begin to rebuild almost from scratch because the damages to our medical care and our infrastructure in the country and also the emotional state of our people will require massive investments. Unfortunately, TB will not be a priority investment, and that is why we need the unified efforts of our partners to have organizational support to help our people.”
Prof. Alexandru Rafila, Minister of Health, Romania
“Romania is a country with a long border, we share over 600 km with Ukraine, and we have an important flow of people coming into our country, including more than 30,000 children, some of them without their parents. It’s a big challenge for Romanian authorities, but not yet for health authorities. But it’s possible that in the next days or weeks, if the stupid war won’t stop, we will have to put in place a big effort regarding the health sector.”
“During this crisis, there is an advantage because Romania has in place a network of TB hospitals and TB ambulatory care centers where we can perform rapid diagnosis and treatment. We already have support from the Global Fund regarding the acquisition of rapid molecular tests, and also to procure treatments for regimens regimen similar to the ones provided in Ukraine.”
Dr. Nino Berdzuli, Director of the Division of Country Health Programmes, World Health Organization (WHO)
“The COVID-19 pandemic has resulted in severely disrupted health services in Europe. Multi-drug resistant TB, HIV/TB co-infection and late diagnosis are persistent challenges, particularly in Eastern Europe. The Russian military offensive will take us back in the TB response to a situation far worse than the COVID pandemic.
“Before the war, Ukraine was the most dynamic country in terms of government efforts to reform the health system and move towards universal health coverage. Ukraine has progressive policies and accelerated transformation of TB services.”
“The humanitarian crisis as a result of the military offensive and the largest displacement since 1945 will set us further back in terms of the TB response and needs. We need to have decisive and collective action here. First, we need to provide an immediate response inside and outside Ukraine. Our teams are relentlessly working to find short- and medium-term solutions, making emergency stocks of drugs available for patients.”