The World Health Organization’s recently released Global Tuberculosis Report 2023 sheds light on the global efforts to combat tuberculosis (TB), offering insights into the state of the epidemic, prevention strategies, and treatment progress. As we delve into the report, a notable highlight emerges – India’s significant strides in TB management, coupled with challenges that may hinder the achievement of the 2025 deadline to eliminate TB.
The WHO Global Tuberculosis Report 2023 provides a comprehensive and up-to-date assessment of the TB epidemic and of progress in prevention, diagnosis and treatment of the disease, at global, regional and country levels. This is done in the context of global TB commitments, strategies and targets. The 2023 edition of the report is, as usual, based primarily on data gathered by WHO from national ministries of health in annual rounds of data collection. In 2023, 192 countries and areas with more than 99% of the world’s population and TB cases reported data.
India’s Progress in TB Management
India, a country bearing 27 percent of the world’s TB burden, has made commendable progress in reducing TB incidence and mortality. According to the report, India witnessed a 16 percent reduction in TB incidence from 2015 to 2022, outpacing the global decline of 8.7 percent. TB mortality in India also saw an 18 percent decrease during the same period, aligning with global trends.
The WHO specifically praised India for its success in managing TB, acknowledging the country’s efforts in improving case detection and mitigating the impact of COVID-19 on TB programs. TB treatment coverage in India has risen to 80 percent, marking a 19 percent increase from the previous year.
Challenges in Achieving Targets
However, amid these achievements, challenges loom large. The report underscores India’s struggle to meet key TB indicators by 2025, as compared to 2015 levels. Despite recovering losses in TB detection during 2022, India, in line with global trends, is likely to fall short of achieving crucial milestones.
In the aftermath of the COVID-19 pandemic, the report reveals a global recovery in TB diagnoses and treatments in 2022, mitigating the pandemic’s adverse effects on TB-related deaths and illnesses. Yet, TB remains the second leading cause of death from a single infectious agent globally, following COVID-19. The reported global number of newly diagnosed TB cases reached 7.5 million in 2022, the highest since WHO’s global TB monitoring began in 1995.
India, along with Indonesia and the Philippines, had experienced substantial reductions in newly diagnosed TB cases in 2020 and 2021 due to the pandemic. However, in 2022, all three countries surpassed 2019 levels, indicating a rebound in TB detection. It is essential to note that the increase in 2022 might include a backlog of cases from previous years, delayed by COVID-related disruptions.
3. Global TB Landscape in 2022
Globally, TB caused an estimated 1.30 million deaths in 2022, down from 1.4 million in both 2020 and 2021. COVID-related disruptions are estimated to have led to nearly half a million excess TB deaths from 2020 to 2022 compared to pre-pandemic trends. The net reduction in global TB deaths from 2015 to 2022 is 19 percent, falling short of the WHO End TB Strategy milestone of a 75 percent reduction by 2025.
Despite progress in the WHO African and European regions, where 47 countries achieved reductions of at least 35 percent, worldwide, 10.6 million people developed TB in 2022. This figure is up from 10.3 million in 2021 and 10.0 million in 2020, indicating a potential return to the pre-pandemic downward trend in 2023 or 2024.
The global gap between estimated TB incidence and reported newly diagnosed cases narrowed to 3.1 million in 2022, down from around 4 million in both 2020 and 2021. However, the estimated TB incidence rate of 133 new cases per 100,000 population in 2022 represents only an 8.7 percent reduction from 2015 to 2022, falling short of the WHO End TB Strategy milestone of a 50 percent reduction by 2025.
India, as one of the thirty high TB burden countries, accounted for 27 percent of global TB cases in 2022. The country, alongside Indonesia, China, and others, faces the challenge of narrowing the gap between estimated TB incidence and newly diagnosed cases, a critical aspect of any TB elimination program.
Addressing Multidrug-Resistant TB (MDR/RR-TB)
A major concern highlighted in the report is the rise of multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). Globally, an estimated 410,000 people developed MDR/RR-TB in 2022, with only 175,650 diagnosed and started on treatment. India, contributing 27 percent to the global MDR/RR-TB cases, faces the challenge of improving detection and treatment rates, which still lag behind pre-pandemic levels.
National surveys and up-to-date cause-of-death data are crucial for accurate estimation of TB burden post-COVID. The report emphasizes that global targets set for the 2018–2022 period were not achieved. Of the 5-year target to treat 40 million TB patients, only 34 million were treated. Similarly, the target of initiating preventive treatment for 30 million people saw a 52 percent achievement, with 3.8 million people receiving preventive treatment in 2022.
Financial Constraints and Global Targets
Financial constraints persist in the fight against TB. In 2022, only $5.8 billion was available for TB diagnosis, treatment, and prevention services, falling below the pre-COVID levels and less than half of the $13 billion target per year by 2022. Investment in TB research averaged just under $1 billion per year, less than half of the $2 billion target.
The economic and financial barriers to accessing and completing TB treatment are evident, with about 50 percent of TB patients and their households facing catastrophic costs. The WHO End TB Strategy aims for zero catastrophic costs, emphasizing the need for progress towards Universal Health Coverage (UHC) and improved social protection.
Treatment success rates have improved, reaching 88 percent for people treated for drug-susceptible TB and 63 percent for those with MDR/RR-TB. Despite these successes, ending the global TB epidemic requires translating commitments made at the 2023 UN high-level meeting on TB into concrete actions.
A Call for Global Collaboration
As India navigates the complex landscape of TB control and prevention, the report highlights both achievements and challenges. The country’s success in improving case detection, reducing TB incidence and mortality, and enhancing treatment coverage is commendable. However, the looming deadline of 2025 to eliminate TB necessitates intensified efforts, addressing gaps in detection, treatment, and financial support. It’s a call for sustained momentum and global collaboration to overcome the hurdles and ensure a TB-free future for all.
Key Findings of the Report:
- Global Recovery in TB Diagnoses and Treatment (2022):
- Major recovery after 2 years of COVID-related disruptions.
- Started to reverse the damaging impact of the pandemic on TB-related deaths and illnesses.
- TB remained the second leading cause of death globally in 2022, after COVID-19.
- Global TB targets have been missed or remain off track.
- Global Newly Diagnosed TB Cases (2022):
- Reported global cases: 7.5 million (highest since WHO global TB monitoring began in 1995).
- Above pre-COVID baseline and previous peak in 2019.
- Up from 5.8 million in 2020 and 6.4 million in 2021.
- Possibly includes a backlog from previous years due to COVID-related disruptions.
- Recovery in High TB Burden Countries (2022):
- India, Indonesia, and the Philippines collectively recovered to above 2019 levels in 2022.
- Global TB Deaths (2022):
- Estimated 1.30 million deaths (down from estimates in 2020 and 2021).
- COVID-related disruptions resulted in almost half a million excess deaths from TB (2020–2022).
- Net reduction in global TB deaths from 2015 to 2022 was 19%, falling short of the WHO target of 75% reduction by 2025.
- Better progress in the WHO African and European regions, with 47 countries achieving reductions of at least 35%.
- Global TB Incidence (2022):
- Estimated 10.6 million new TB cases in 2022 (up from estimates in 2020 and 2021).
- Global gap between estimated incident cases and reported notified cases narrowed to 3.1 million in 2022.
- Global TB incidence rate (new cases per 100,000 population per year) was 133 in 2022, with a net reduction of 8.7% from 2015 to 2022.
- High TB Burden Countries (2022):
- Thirty high TB burden countries accounted for 87% of global TB cases.
- Two-thirds of the global total in eight countries: India (27%), Indonesia (10%), China (7.1%), the Philippines (7.0%), Pakistan (5.7%), Nigeria (4.5%), Bangladesh (3.6%), and the Democratic Republic of the Congo (3.0%).
- Demographics of TB Cases (2022):
- In 2022, 55% of people who developed TB were men, 33% were women, and 12% were children (aged 0–14 years).
- Multidrug-Resistant TB (MDR/RR-TB) (2022):
- Estimated 410,000 people developed MDR/RR-TB in 2022.
- 175,650 people diagnosed and started on treatment, still below the pre-pandemic level of 2019.
- Need for Accurate Data and Global Targets (2022):
- New national surveys of TB disease and up-to-date cause-of-death data are needed for accurate estimation of TB disease burden in the post-COVID period.
- Global targets set at the first UN high-level meeting on TB for the 5-year period 2018–2022 were not achieved.
- Global TB Treatment and Preventive Measures (2022):
- 34 million people treated for TB, 84% of the 5-year target of 40 million.
- 15.5 million people initiated on TB preventive treatment, 52% of the 5-year target of 30 million (including 3.8 million people in 2022, above the pre-pandemic level of 3.6 million in 2019).
- US$ 5.8 billion available for TB diagnosis, treatment, and prevention services in 2022 (below pre-COVID levels and less than half of the target of at least US$ 13 billion per year by 2022).
- Investment in TB research averaged just under US$ 1 billion per year, less than half of the US$ 2 billion target.
- Economic and Financial Barriers to TB Treatment (2022):
- About 50% of TB patients and their households face total costs (direct medical expenditures, non-medical expenditures, and indirect costs such as income losses) that are catastrophic (>20% of annual household income).
- Far from the WHO End TB Strategy target of zero, indicating significant economic and financial barriers.
- Treatment success rates have improved: 88% for people treated for drug-susceptible TB and 63% for people with MDR/RR-TB.
- Ending the Global TB Epidemic (2023):
- Requires translating commitments made at the 2023 UN high-level meeting on TB into action.
References:
- WHO Global TB Report 2023
- India’s Success in Reducing TB Incidence Acknowledged in WHO’s Global TB Report 2023: Health Ministry
- The road to elimination of tuberculosis, the road to India’s success
- WHO hailed India’s success in managing TB: Union Health Ministry
- TB Goals in India: Insights from WHO’s Global TB Report 2023
- India’s TB Mortality: Report 2023 Explained
Photo Credits: AP Photos/ Anupam Nath