In 2020, we have all learned what a pandemic is, but we may have failed to recognize the relevance of other ongoing pandemics. On World Tuberculosis Day, we reflect upon this disease and its own pandemic, the factors related to it and the relevance of the fight against it. Why is tuberculosis still an issue? Why mustn’t we forget about it? But, what is more important, what can we learn from our previous mistakes? Tuberculosis patients will suffer further consequences because we were unable to optimize our efforts, but we have a great opportunity now to try to re-build for a better future.

Is COVID-19 the only pandemic?

During the course of the past year, the COVD-19 health emergency has forced us all to become familiar with the term pandemic, but defining what a pandemic is poses a difficult challenge. Most of the traditional definitions state that it is the spread of an infectious disease’s epidemic across a large region, generally multiple continents or worldwide, affecting large numbers of people.

As the TB alliance has smartly stated, this new viral infection is not the only one fulfilling the requisites: tuberculosis (TB) is present in every country of the world, being the leading cause of death from infectious diseases globally, and, according to WHO’s estimates, almost 25% of the world’s population maybe be infected with Mycobacterium tuberculosis, the pathogenic bacteria causing the disease.

Why is tuberculosis still an issue?

According to the latest data in the WHO Global TB Report 2020, 10 million people fell ill with TB and almost 1 and a half million died from it in 2019. Given that we are talking about a completely preventable and curable disease, it is important to try to understand some of the main factors that may be contributing to failure in controlling the situation.

On the one hand, TB spreads through the air when ill people cough or sneeze. This, combined with the fact that only 5 to 15% of infected develop disease, complicates any attempt to control infection in any given population. On the other hand, treatment for non-resistant TB implies a 6-month course of a combination of 4 different antibiotics, which becomes more complex for resistant TB disease. Lack of adherence causes relapse cases and enhances development of resistance versions of the infection and can only be fought with support from health workers or trained volunteers, a service that not every health system is prepared to offer.

Why is it important to fight against tuberculosis?

The TB pandemic is not only a global but also a transversal problem. Among other issues, tuberculosis is strongly correlated with HIV infection, antimicrobial resistance and inequity. Firstly, tuberculosis is the most common illness and leading cause of death among people living with HIV, with estimates blaming it for nearly 1 in 3 HIV-associated deaths. Secondly, rifampicin-resistant (RR-TB) and multi-drug resistant (MDR-TB) M. tuberculosis strains are becoming more frequent while only one third of these resistant cases are detected and only 60% of those starting the longer, less effective and more expensive appropriate treatment are successfully cured. And, lastly, as mentioned above, tuberculosis is present all over the world, but it is important to notice that two thirds of the global new cases occur in 8 countries and 24% of them only in India.

What can we learn from pandemics?

While nobody doubts the importance of the fight against COVID-19, we should realize that we may have forgotten the relevance of other battles that also need to be won. TB is an example of how this negligence can have major impacts:  it is estimated, for example, that TB annual deaths could rise to 2015 or 2012 levels and an additional 6.3 million cases will occur between 2020 and 2025, all as a consequence of the COVID-19 pandemic and how it has been managed.

Pandemics have been there before March 2020, and we still have not learned how to optimize our efforts. Therefore, it is of crucial significance that we, as a globalized world, take this opportunity to reflect upon how we face health and how we build our health systems so that we can effectively target all global health challenges, existing and new, in a way in which no one is left behind.

Almudena Sanz Gutiérrez
Almudena Sanz Gutiérrez

Almudena Sanz Gutiérrez has recently graduated from the Biotechnology degree at the Universidad Politécnica de Madrid and is continuing her scientific education with the MSc Clinical Research – International Health track at the Universidad de Barcelona. She is passionate about translational research on global health topics in general and those related to health equity in particular, and looks forward to developing a career as a researcher.


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