Published on Investing in Health

Now, more than ever, we must recommit to the demise of TB

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A doctor reviewing a patient?s x-ray A doctor reviewing a patient’s x-ray

Even as COVID-19 has captured most of the world’s attention over the last year, it’s essential that we keep our eyes on the other lurking threats to global health.

That’s especially important when it comes to tuberculosis (TB) which, each year, continues to infect about 10 million people and lead to about 1.2 million deaths. In recent years, there have been some gains in the fight against TB. But, even as the world has had nearly 140 years to tame this devastating scourge since it was first discovered, the current trajectory of progress appears too weak to meet the global goals for its demise.

Indeed, “The Clock is Ticking,” the theme for World TB Day 2021, which the world observes today, is a reminder of the urgency of beating TB and the peril of ignoring it. The World Bank continues to play a key role in supporting analytic work and investments  to strengthen  prevention, detection, and treatment of TB, especially where it is most prevalent.

More efficient and effective spending

Among those efforts, the Bank has in recent years enabled the development of Optima TB, a tool that gives national decision-makers a better understanding of the burden of TB in their own country. The tool describes how they might use their resources more effectively and efficiently to tackle TB. It has proven to be valuable not just to health officials, but also to ministers of finance who are always pressing for ways to make spending go further.

The Optima TB software was developed by the Optima Consortium for Decision Science (a collaboration of University College London and the Burnet Institute in the United Kingdom), with technical input from the World Bank. So far, it has provided technical support to several countries, including Belarus, Indonesia, Moldova, Mozambique, Romania, and South Africa, in helping them better manage their TB programs.  

In Belarus, for example, Optima showed how the country could shift from hospital-based TB care to extended ambulatory care, to help free up about one-third of its TB budget.

In Mozambique, where high levels of HIV compromise immune systems and render people more susceptible to TB, the tool illustrated the importance of intensifying contact tracing and case finding.  It was particularly useful for high-risk populations, regularly screening all HIV patients for TB,  improving the effectiveness of out-patient screenings and enhancing health data collection.

Health system strengthening

Other World Bank efforts against TB have helped strengthen health systems in critical health care capabilities that address both TB and other diseases. This, in turn has allowed countries to achieve economies of scale and respond to a range of threats. This is the approach used for several regional projects in Eastern and Southern Africa –where TB cases are relatively high either because of the prevalence of HIV and also because of the large number of miners, a group that is more vulnerable to TB.  

For instance, under the East Africa Public Health Laboratory Networking Project (EAPHLNP) supporting Burundi, Kenya, Rwanda, Tanzania, and Uganda, diagnostic and surveillance capacities were strengthened for both TB and other public health threats over the past decade.  The project has improved the speed and quality of TB diagnosis with the establishment of 40 state-of-the-art public health laboratories with biosafety, infection control, waste management capacity and strengthened human resources. It has also helped with bolstering disease outbreak preparedness and response capacities to deal with frequent outbreaks and, now, COVID-19.

As the governor of Wajir County, Kenya, Mohamed Abdi Mohamud, said last year: “our referral laboratory, with skilled and dedicated staff, has been a great asset to the community and the entire region as a reference laboratory in clinical diagnosis, disease surveillance and outbreak investigations.” He pointed to the pivotal role the laboratory played during numerous outbreaks, including measles in 2013, Cholera in 2015 and 2019, Dengue fever in 2017, Kala-azar in 2018 and Rift Valley Fever in 2018.

The EAPHLNP project has played a key role in strengthening laboratory diagnostics. The acquisition of new molecular technologies with multi-platform applications for testing different disease-causing agents has been a game-changer.  A notable example are the GeneXpert machines, which accurately diagnose drug resistant TB in hours rather than waiting for weeks or months to get culture results. These machines are now proving valuable for the SARS-COV-2 rapid testing at peripheral facilities—allowing suspected cases to be tested locally rather than sending specimens or patients to capital cities.

Another Bank-funded project – the South Africa TB and Health Systems Project – helped improve coverage and quality of TB control and occupational lung disease (particularly among miners) in Lesotho, Malawi, Mozambique and Zambia. The project helped countries enhance their capacities to respond to emergencies and public health events across the region. It also enabled them to mitigate the impacts of COVID-19, which has severely disrupted essential health services and significantly sidetracked many years of substantial progress aimed at achieving global health targets of the SDGs. 

The shock of COVID-19

As noted earlier, the arrival of the COVID-19 pandemic has upended much of the previous in the global reduction of TB. The Stop TB Partnership recently reported that, a year after the arrival of COVID-19, nine countries with the most TB cases – about 60 percent of the global TB burden – experienced a “drastic decline in diagnosis and treatment of TB infections in 2020.” That brings the world back to 2008 levels.  

Also, because COVID-19 is a virulent respiratory disease, it presents grave hazards to anyone already infected with TB. The Stop TB Partnership cites studies from India and South Africa showing that people coinfected with TB and COVID-19 have three times higher mortality rates than people infected with TB alone.

It will take a great deal of commitment and resources to put the global struggle against TB back on track, in the coming years. As TB infection and mortality rates remain at stubbornly high levels, it is time – especially on World TB Day – to recommit to its ultimately demise.


Feng Zhao

Practice Manager

Miriam Schneidman

Lead Health Specialist, World Bank Africa Region

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