Tuberculosis killed 1.4 million people in 2019

At a time when humanity is scared by the million lives that covid-19 has claimed in just under a year, the World Health Organization (WHO) has published its annual report on another less-known pandemic on Wednesday For the common of the mortals, but as much or more lethal than the new coronavirus that crowds the news: tuberculosis killed 1.4 million people in 2019, almost four thousand a day, and infected almost 11 million.

It is a preventable and curable disease: in fact 85% of those who contract it heal after undergoing treatment for six months and in many countries it is only a memory of the past.

But tuberculosis remains one of the world's leading causes of death along with malaria and the deadliest infectious disease, even ahead of AIDS.

Caused by the

bacillus

, which is transmitted when patients shed bacteria into the air, for example by coughing, this ailment that usually attacks the lungs is present in a quarter of the world's population, mainly adult men in poor countries.

More information

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• Everything that the coronavirus will stop: the fight against the epidemics that kill the most

• Tuberculosis killer bacteria caused 1.5 million deaths in 2018

This latest report presented today by the WHO has been prepared with data from 198 States and territories that represent more than 99% of the world population and the number of estimated cases.

The findings show a slight decrease compared to the previous year in the path of international good intentions, since it must not be forgotten that 60 million lives have been saved in the last two decades.

But it is still far from what is desired: not even 50% of compliance with practically any of the planned goals has been achieved, such as the percentage of reduction in mortality, the increase in people in preventive treatment or with access to medication.

“Almost all the indicators have improved and we are taking steps in the right direction, but we still don't like the current photo;

we are very far from achieving what we have set ourselves ”, reflects Alberto García Basteiro, epidemiologist at the Barcelona Institute for Global Health.

"2019 has not been a bad year in tuberculosis control, but substantial improvements are needed," he adds.

Some 7.1 million people were diagnosed for the first time in 2019, a record number in the last decade, mainly in India and Indonesia, the two countries with the most cases in the world.

However, there is still a large gap between this number and the estimated 10 million who have developed the disease throughout the year, which means that almost three million men and women have it and do not know it, thus Which can spread around them and can end up dying due to not having health care.

In addition, of the TB patients, 69% were also HIV positive.

And of the almost half a million that currently have both diseases, 88% are on antiretroviral therapy.

The treatment success rate for people newly enrolled in treatment in 2018 was 85%.

The economic and human cost of not ending tuberculosis by 2030 will be about $ 3 billion

In addition, these data refer to the period from 2015 to 2019, that is to say: Covid-19 cannot be blamed for having weighed down the efforts to eradicate tuberculosis, since it had not yet reached our lives.

However, the new coronavirus can cloud the future, as previous analyzes have predicted.

The WHO warns again that the pandemic threatens to reverse progress:

If the health services dedicated to the detection and treatment of the sick are interrupted for just three months, deaths could increase between 0.2 and 0.4 million in 2020. And this is something that is already happening: in Indonesia, India and The Philippines, which together account for 44% of cases, saw sharp drops in the number of people diagnosed during the first six months of this year.

“This does not mean that there is a decrease in the disease, but that it is ceasing to notify.

And a tuberculosis that is not treated is a tuberculosis that usually ends in death.

It is very worrying because in 2020 there will be less diagnosis and transmission at the home level will probably increase, and therefore the number of patients ”, warns García Basteiro.

Data collection and presentation has also been affected, as has the reduction in the use of GenXpert machines, commonly used to diagnose tuberculosis but now being used for COVID-19 testing.

Added to this is that the vaccine used against the disease is over a hundred years old and quite limited, while the new immunization is still in the testing phase.

The economic impact of the pandemic will worsen two of the key determinants in the incidence of the disease: malnutrition and GDP per capita, in such a way that the number of people who can be infected in the next five years could increase by more than a million annual.

A new report to be published next week by a team of researchers from Harvard University and the University of California at the 51st World Conference of The Union on Lung Health goes further: that the economic and human cost of not ending tuberculosis 2030 will be about $ 3 billion.

This figure includes losses in income growth and the social value of some 5.7 million preventable deaths in 120 countries.

"The report shows that our collective failure to invest in the health of our citizens and defeat preventable, treatable and curable diseases such as tuberculosis, by default has also left us terribly exposed to covid-19," reflects José Luis Castro, executive director of the International Union against Tuberculosis and Lung Diseases (The Union).

Not even 50% of the goals have been reached

The task to be carried out to eradicate tuberculosis was set by the member countries of the UN and WHO in 2015, with the approval of the Sustainable Development Goals (SDG).

These were highlighted and expanded with a political statement that emerged from a meeting in the framework of the UN General Assembly in 2018 and that was the first time that world leaders sat down to discuss the problem at the highest level.

The balance of what has been achieved will be done in 2030, but now, five years later, the data shows that these goals will not be achieved and that what has been achieved does not even reach half of what is intended.

It can be seen, to begin with, in the three main goals: the incidence should have been reduced by 20% and has only reached 9%;

deaths should have dropped by 35% and have only done so by 14%, and patients affected by so-called “catastrophic costs” - that is, when treatment expenses represent 20% or more of the annual income of a family - should be 0%, that is, none, and yet they affected 49% of the patients.

The same has happened in terms of access to preventive treatment, which have received 6.3 million tuberculosis patients compared to the 30 million who wanted to reach, and medication for the sick, which has been provided to 14.1 million people instead of the 40 million who would have needed it.

In terms of funding, $ 6.5 billion of the $ 13 billion needed was raised, and $ 906 million of the $ 2 billion required for research.

There is also concern about the progress in the cure of patients with multidrug-resistant tuberculosis, that is, that which occurs when the bacteria that cause the disease stop responding to the two most potent antibiotics, isoniazid and rifampin.

There have been advances in the testing, detection and treatment of this variety: in 2019, more people with the diagnosed disease underwent drug resistance tests and more patients of this type were detected.

But the number of people enrolled in multidrug-resistant tuberculosis treatments is only 38% of what is estimated to be there.

Europe and Africa have seen significant improvements in reducing the incidence of tuberculosis and mortality

The WHO does not stop pointing out in its report that there are certain positive data: Europe has almost fully complied after having reduced the incidence of the disease by 19% and mortality by 31%.

And Africa has also come a long way, with a decline of 16% and 19% respectively.

In total, 78 countries do have a chance of reaching the established targets in terms of infection rates, including seven that have already done so despite their high tuberculosis burden ―Cambodia, Kenya, Ethiopia, Namibia, Russia, South Africa and Tanzania― and three others are about to do so: Lesotho, Myanmar and Zimbabwe.

The same happens with the drop in mortality: 46 countries are close to reaching the planned goal, of which seven have already done so - Bangladesh, Kenya, Mozambique, Myanmar, Russia, Sierra Leone and Tanzania.

García Basteiro affirms that the economic crisis derived from covid-19 will lead to an increase in the population vulnerable to the disease.

"And we know that social determinants are key in transmission, so all those that lead to worse economic development, lower GDP in countries or a greater number of people who do not have to eat will be risk factors."

For Castro, the new coronavirus has been a bitter pill to swallow, but the lesson that must be learned the most is the following: "understand and accept that investing in health systems is investing in preparedness for a pandemic."

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