Worrying lack of funding for TB

Tuberculosis is both curable and preventable, yet globally more than 1 million people die each year from the disease. The COVID-19 pandemic has worsened this situation further: in 2020, there were around 10 million cases of tuberculosis and, for the first time in 10 years, there was an increase in deaths from tuberculosis—1·5 million people died from tuberculosis in 2020 (including an estimated 1·3 million HIV-negative people and 214 000 people with HIV). The total number of deaths in 2020 reflect levels that were last noted in 2017. Additionally, there was an 18% decrease in the number of cases diagnosed and reported from 7·1 million in 2019 to 5·8 million in 2020, a 15% reduction in the number of individuals treated for drug-resistant tuberculosis, and a 21% decrease in the number receiving tuberculosis preventive treatment, probably due to reduced access to resources and care. The COVID-19 pandemic has reversed years of progress made in the global fight against tuberculosis.

Yet, despite the worrying increase in tuberculosis burden and mortality, funding for tuberculosis research is woefully inadequate and has flatlined since 2018. A report by the Stop TB Partnership and Treatment Action Group showed that in 2020, funding for tuberculosis research reached only US$915 million, far short of the global political commitment to increase funding to the UN goal of $2 billion annually. This target was committed to by country governments at the 2018 UN High-Level Meeting on Tuberculosis, but this commitment has not been upheld. Additionally, between 2016 and 2020, cumulative funding for tuberculosis research amounted to only $4·2 billion—much less than the $9 billion target called for in the Stop TB Partnership's Global Plan to End TB. A small positive finding was that funding for paediatric research increased from $58 million in 2019 to $91 million in 2020, a necessity considering around 1·1 million children were ill with tuberculosis in 2020, and that paediatric tuberculosis can be difficult to diagnose and treat.

To close the funding gaps, the report authors estimate that around $10 billion will be needed in the next 2 years—including $5·8 billion for drug research, $2·7 billion for vaccines research, and $613 million for diagnostics research—a target that is unlikely to be met without a change in political will, attitude, and investment directed towards ending tuberculosis. Madhukar Pai (McGill International TB Centre, McGill University, Montreal, QC, Canada) is unsurprised by the findings, commenting: “Tuberculosis has been underfunded for decades, especially with research and development. Nothing is more telling than the fact that we are still using a vaccine (BCG) that was developed in 1921!” Mel Spigelman, (TB Alliance, New York, NY, USA) echoed these sentiments, commenting: “Unfortunately, the fight against tuberculosis has never generated anywhere near the needed resources and has actually slid backwards in the face of COVID-19, resulting in a worsening of the global tuberculosis situation.”

The lack of funding for tuberculosis is in stark contrast to the staggering amounts of money spent on COVID-19. The report notes that in the first 11 months of the COVID-19 pandemic, $104 billion was spent on research and development of COVID-19 vaccines and therapeutics—113 times more than the amount spent in 2020 by funders into tuberculosis research and 162 times more than the amount spent by governments, despite tuberculosis being the second-largest infectious disease killer after COVID-19. The financing disparity between the two diseases seems to be driven by economics, where vaccinating wealthy high-income nations against COVID-19 has been prioritised over vaccination and managing other diseases such as tuberculosis in low-income countries. Pai said that “investments in COVID-19 research and development is several orders of magnitude higher than tuberculosis, and that is because the pandemic is affecting privileged people in the global north. Tuberculosis is seen as a problem that affects the poor and the marginalised in the global south. So, nobody cares—it's that simple. For the tuberculosis situation to improve, the COVID-19 emergency has to end. For that to happen, we need to end the shameful vaccine apartheid and equitably vaccinate the world”.

Spigelman commented: “The COVID-19 pandemic has taught us many lessons. [Some] of the most important ones have been that it requires significant investment and resources to discover and develop the tools necessary to effectively fight a pandemic and that new tools must be made available globally and equitably.” He continued: “The investments committed on a global scale towards control of COVID-19 have been critical. Similar resources need to be committed to the age-old struggle against the tuberculosis pandemic, which was only surpassed recently by COVID-19 as the world's top infectious disease killer. Will policymakers learn the lessons clearly taught by COVID-19?”

Source: The Lancet Infectious Diseases