According to the report, the COVID-19 pandemic has reversed years of progress in providing essential TB services and in reducing the TB disease burden. There is only one year left to achieve the historic 2022 TB targets committed to by heads of state and government at the first United Nations high-level meeting on TB in 2018. Despite the historic commitment, progress towards the global TB targets is mostly off-track. Only a few countries can tell success stories.
Historic targets out of reach
On October 10, 2018, the United Nations General Assembly adopted the “Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis”. In it, governments agreed 10 key targets, and five key commitments.
Among the key targets with a link to alcohol harm are:
- Commit to provide diagnosis and treatment;
- Commit to prevent TB; and
- Commit to mobilize sufficient and sustainable financing.
Among the key commitments made in the 2018 Political Declaration with a link to alcohol as TB risk factor are:
- Reach all people by closing the gaps on TB diagnosis, treatment and prevention;
- Transform the TB response to be equitable, rights-based, and people-centered;
- Invest the funds necessary to end TB; and
- Commit to decisive and accountable global leadership including regular UN reporting and review.
Nevertheless, these commitments have not facilitate adequate action. Therefore, the key targets remain out of reach.
Unfortunately, today’s report confirms what we all feared – that more and more people are dying from TB. We now see more than 4,100 people dying from TB every single day,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership, as per Health Policy Watch.
This is not a prediction; it is a reality. The COVID-19 pandemic combined with low political will and appallingly low levels of funding have reversed hard-fought gains in the fight against this age-old disease.”
Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership
Alcohol major TB risk factor
The report states that the TB epidemic is strongly influenced by social and economic development and five health-related risk factors:
- Undernutrition
- Diabetes
- HIV infection
- Alcohol use disorders
- Smoking
Therefore, achieving the global targets for reductions in the TB disease burden requires progress on reducing and preventing these risk factors. The report identifies alcohol as one of the major risk factors for TB.
It is estimated that globally, in 2020, alcohol use disorders were the cause 740,000 TB cases. Among the above five health-related risk factors alcohol use disorders is the second highest preventable cause of TB along with HIV/ AIDS, second only to undernutrition.
Undernutrition, in itself, is also driven by alcohol harm, according to Movendi International analysis.
The extent of alcohol’s burden on TB varies across countries. In 30 countries with a high TB burden, out of the five health-related risk factors, alcohol use disorders is the highest preventable cause for TB in the Russian Federation and the second highest in Brazil, Cambodia, China, India, Mongolia, Thailand, Viet Nam, Zambia and Zimbabwe.
Global estimates of the number of TB cases attributable to selected risk factors, 2020
| Risk factor | Relative risk (uncertainty interval) | Exposed (millions) | Population attributable fraction (%) | Attributable TB cases (millions, uncertainty interval) |
|---|---|---|---|---|
| Alcohol use disorder | 3.3 (2.1-5.2) | 291,000 | 8.1 | 0.74 (0.31-1.3) |
| Diabetes | 1.5 (1.3-1.8) | 496,000 | 3.1 | 0.37 (0.15-0.68) |
| HIV infection | 18 | 37,500 | 7.6 | 0.74 (0.65-0.83) |
| Smoking | 1.6 (1.2-2.1) | 1,050,000 | 7.1 | 0.73 (0.25-1.5) |
| Undernourishment | 3.2 (3.1-3.3) | 637,000 | 15 | 1.9 (1.3-2.6) |
Notably, the report only considers the contribution of alcohol use disorders to the TB epidemic to avoid confounders. Therefore, the actual alcohol-related TB burden is likely greater than what is reported.
Another gap in the 2021 WHO Global Diabetes Report is concerning: alcohol policy solutions, especially those included in the SAFER technical package, are not mentioned in the report. Alcohol taxation should feature in the discussion of domestic resource mobilization and prevention of TB; screening and brief interventions for alcohol use disorder should also feature in the discussion of treatment; and other alcohol policy best buy solutions should be addressed in the chapter on TB prevention – especially concerning the magnitude of alcohol’s contribution to the growing TB burden.
Already in 2018, Movendi International was the leading advocacy voice for addressing alcohol’s role in the TB epidemic in the Political Declaration of the UN’s High-Level Meeting. Alcohol is a serious TB risk factor and alcohol policy measures are effective solutions to help reduce and prevent TB.
Ending this debilitating disease remains a priority for WHO, and in recent years, we have made encouraging progress globally,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, as per the report.
But the COVID-19 pandemic has put these gains at risk. Not only does the virus pose an increased risk to people with TB, it has also caused severe disruption to services.”
Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO
Other key findings from the report
- The number of people newly diagnosed with TB and reported fell from 7.1 million in 2019 to 5.8 million in 2020, an 18% decline back to the level of 2012 and far below the approximately 10 million people who developed TB in 2020.
- 16 countries accounted for 93% of this reduction in diagnosis and reporting, with India, Indonesia and the Philippines the worst affected. Provisional data up to June 2021 show ongoing shortfalls.
- It is estimated that in 2020 there were 1.3 million TB deaths among HIV-negative people (up from 1.2 million in 2019) and an additional 214, 000 among HIV-positive people (up from 209,000 in 2019), with the combined total back to the level of 2017.
- Declines in TB incidence (the number of people developing TB each year) achieved in previous years has almost come to a halt. These impacts are forecast to be much worse in 2021 and 2022.
- The number of people provided with treatment for drug-resistant TB declined by 15% between 2019 and 2020 from 177,100 to 150,359 people or about one in three of those in need.
- TB preventive treatment declined by 21% between 2019 and 2020 from 3.6 million to 2.8 million people.
- Global spending on TB diagnostic, treatment and prevention services reduced from US$ 5.8 billion to US$ 5.3 billion. This is less than half of what is needed.
If we had spent a fraction of the energy and money that governments and pharma have spent developing COVID-19 vaccines and then getting them to wealthy countries, we’d have stopped TB in its tracks long ago,” said Guy Marks, President of the The Union, as per Health Policy Watch.
Guy Marks, President, International Union Against Tuberculosis and Lung Disease (The Union)
The report calls for urgent actions to mitigate and reverse these negative impacts. The immediate priority is to restore access to and provision of essential TB services such that levels of TB case detection and treatment can recover to at least 2019 levels, especially in the most badly-affected countries.
Getting back to the levels that were achieved in pre-COVID times would depend on the key stakeholders, officials, funders and the understanding that these investments and continuation of TB services are needed as soon as possible,” said Dr. Tereza Kasaeva, WHO’s Director of the Global TB Program, as per Health Policy Watch.
Dr. Tereza Kasaeva, WHO – Director of the Global TB Program
For further reading
Alcohol and the “Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis“
The 2018 declaration also outlined the importance of tackling alcohol as risk factor for TB and using alcohol policy solutions, such as alcohol taxation, at least in four paragraphs:
- PP 17: “Recognize the enormous, often catastrophic, economic and social impacts and burden of tuberculosis for people affected by the disease, their households, and affected communities, … high-risk groups and other people who are vulnerable or in vulnerable situations, such as women and children, indigenous peoples, … prisoners, people living with HIV, people who use drugs, … individuals who face food insecurity, … people with mental and physical disabilities, people with alcohol use disorders and people who use tobacco…”;
- PP 29: “… commit to coordination and collaboration between tuberculosis and HIV programmes, as well as with other health programmes and sectors, to ensure universal access to integrated prevention, diagnosis, treatment and care services, … providing tuberculosis preventive treatment, as well as to eliminate the burden faced by affected people, to leverage resources to maximize impact, and to address the common social, economic and structural determinants of tuberculosis, HIV, viral hepatitis, non-communicable diseases… ;”
- PP 33: “Commit to developing community-based health services through approaches that protect and promote equity, ethics, gender equality and human rights in addressing tuberculosis by focusing on prevention, diagnosis, treatment and care, including socioeconomic and psychosocial support, based on individual needs, that reduce stigma, and integrated care for related health conditions, such as HIV and AIDS, undernutrition, mental health, non-communicable diseases including diabetes and chronic lung disease, and tobacco use, harmful use of alcohol and other substance abuse, …”;
- PP 46: Commit to mobilize sufficient and sustainable financing for universal access to quality prevention, diagnosis, treatment and care of tuberculosis, from all sources, … including by helping developing countries to raise domestic revenues…”
Sources
World Health Organization: “Global Tuberculosis Report 2021“
Health Policy Watch: “COVID-19 Causes Spike in TB Deaths as Case Detection and Treatment Falter“
