Context: According to the Global Tuberculosis Report, 2020 released by the World Health Organization (WHO), India registered a decline in the notification of tuberculosis (TB) cases by about 85 per cent in April this year, after the imposition of the novel coronavirus disease (COVID-19) lockdown.
Key Findings of the Report

• For every 100 cases being registered in India till January 2020, only 40 cases were registered by April due to a decline in access to TB services in the country.
• India, incidentally, has the highest TB burden across the globe, which accounts for 26 per cent of the total global cases. 
• That a huge per cent of potential cases remained out of the TB registration net, could amplify the problems many times for India.
• The weekly and monthly number of TB case notifications fell by more than 50 per cent between the end of March and late April in India, following the imposition of a national lockdown.

Plausible reasons for this decline amid COVID-19

• Delay in procurement and transportation of TB medicines and other laboratory consumables; 
• Restrictions on the movement of people and loss of wages making it difficult to access health centres;
• A fear of stigma given the similarities in some clinical features of TB (for instance fever and cough) with those of COVID-19, excerbated the problem.
• “Many countries reported the use of GeneXpert machines for COVID-19 testing instead of diagnostic testing for TB (43 countries including 13 high TB burden countries, including India).
• Reassignment of staff in national TB programmes to COVID-19 related duties and reallocation of budgets (52 countries including 14 high TB burden countries, including India).
• People were generally discouraged from seeking healthcare and were encouraged to delay it during the months of the lockdown if it was not urgent.
• Even there were general advisories to do so to avoid crowding in health facilities.

Economy contraction and TB 

• Negative impacts on employment opportunities threaten the livelihoods of many millions of people and those most at risk of developing TB are among the most vulnerable.
• According to World Bank estimate, due to the pandemic, the global gross domestic product will contract by 5.2 per cent in 2020, with many countries reporting a much steeper decline.

Global targets

• In 2014 and 2015, all Member States of WHO and the UN adopted the UN Sustainable Development Goals (SDGs) and WHO’s End TB Strategy. 
• The SDGs and End TB Strategy both include targets and milestones for large reductions in TB incidence, TB deaths and costs faced by TB patients and their households.
• TB is included under Goal 3 Target 3.3 of the SDGs which aims to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases” by the year 2030.
• The WHO End TB Strategy aims for a 90 per cent reduction in TB deaths and an 80 per cent reduction in the TB incidence rate by 2030, compared to the 2015 baseline. 
• Milestones for 2020 include a 20% reduction in the TB incidence rate and a 35% reduction in TB deaths.
• But in reality, the world as a whole, is nowhere close to meeting the targets of the 2020 milestones of the ‘End TB Strategy’. 
• As against an aim of reducing TB cases by 20 per cent from 2015-2019, the actual reduction has been just nine per cent.

The UN Political Declaration on TB also included 4 new targets for the period 2018-2022:

• Treat 40 million people for TB disease
• Reach at least 30 million people with TB preventive treatment for a latent TB infection
• Mobilize at least US$13 billion annually for universal access to TB diagnosis, treatment and care
• Mobilize at least US$2 billion annually for TB research

Progress towards global targets

• According to the new report, the WHO European Region is on track to achieve key 2020 targets of the WHO End TB Strategy, with reductions in incidence and deaths of 19% and 31%, respectively, over the last 5-year period. 
• The African Region has also made impressive gains, with corresponding reductions of 16% and 19% in the same timeframe. On a global scale, however, the pace of progress has lagged, and critical 2020 milestones of the End TB Strategy will be missed.

Financing

• As in previous years, most available TB funding (85%) in 2020 came from domestic sources, with Brazil, Russian Federation, India, China and South Africa providing 57% of the global total. 
• International donor funding increased from US$ 900 000 in 2019 to US$ 1 billion in 2020. The Global Fund to Fight AIDS, Tuberculosis and Malaria was the single largest source of international TB financing in 2020, while the United States remains the biggest bilateral funder of efforts to end TB.

Research and innovation

• Reaching the 2030 global TB targets will require technological breakthroughs by 2025. The world needs affordable and accessible rapid point-of-care tests, as well as new, safer and more effective treatments and vaccines. 
• To meet these challenges, Member States called on WHO in 2018 to develop a Global strategy for TB research and innovation that lays out key steps that governments and non-state actors can undertake. The strategy was adopted by the World Health Assembly in August 2020.

Multisectoral action and accountability

• Further progress towards ending TB will depend on action across sectors, underscoring the importance of the implementation of WHO’s multisectoral accountability framework on TB. 
• In 2019 and 2020, WHO worked with high TB-burden countries to ensure the inclusion of accountability mechanisms in national budget planning and pursuing assessment during high-level missions and joint TB programme reviews with engagement of civil society representatives.

Key Facts regarding TB

• Tuberculosis (TB) , the world’s deadliest infectious killer, is caused by bacteria(Mycobacterium tuberculosis)that most often affect the lungs. 
• It can spread when people who are sick with TB expel bacteria into the air – for example, by coughing.
• Approximately 90 percent of those who fall sick with TB each year live in 30 countries. Most people who develop the disease are adults, and there are more cases among men than women.
• TB is preventable and curable. About 85% of people who develop TB disease can be successfully treated with a 6-month drug regimen; treatment has the added benefit of curtailing onward transmission of infection.
• Since 2000, TB treatment has averted more than 60 million deaths – although with access to universal health coverage still falling short, many millions have also missed out on diagnosis and care.
• Eight countries continue to be home to two-thirds of the global total. India is followed by Indonesia (8.5 per cent), China (8.4 per cent), the Philippines (6 per cent), Pakistan (5.7 per cent), Nigeria (4.4 per cent), Bangladesh (3.6 per cent) and South Africa (3.6 per cent).
• Drug-resistant TB continues to be a public health threat. Three countries that had the largest burden of these cases include India (27 per cent), China (14 per cent) and Russia (14 per cent).