Tuberculosis is the second leading cause of infectious disease-related death worldwide, behind only COVID-19. Every day, globally, over 4,100 people die from TB and nearly 30,000 fall ill. Conflict and war like the one in Ukraine, health emergencies such as the COVID-19 pandemic, natural disasters, and mass displacements are complicating and hampering the treatment and prevention of TB and other infectious diseases.
As a humanitarian worker in Ukraine in 2018 and 2019, I watched as Ukrainian health officials worked hard to address a significant tuberculosis (TB) burden amid ongoing conflict in the eastern part of the country. Ukraine has one of the world’s highest rates of drug-resistant tuberculosis, an especially virulent form of the disease that is much harder to treat and thus represents a major public health threat. Prior to the pandemic, the treatment success rate for drug-resistant TB in Ukraine was around 50%, meaning nearly half of the people treated for it did not recover.
Health workers have been steadily modernizing the country’s Soviet era treatment system in order to improve patient outcomes. But the recent full-scale invasion of Ukraine — and the subsequent destruction of health facilities, supply chain breakdown for medicines and medical supplies, and mass displacement — threatens to overturn the progress the country has made in detecting and treating TB. As Mike Ryan, executive director of the World Health Organization (WHO) health emergencies program, said, “The conditions we see in Ukraine are the worst possible ingredients for the amplification and spread of infectious disease.”
A German radiologist screens for tuberculosis in x-ray images of a Ukrainian refugee's lungs. Photo: Matthias Balk/picture alliance via Getty Images
COVID-19 Set Back Progress Against Tuberculosis
Even before the current conflict, Ukraine’s efforts to curb TB had faced setbacks caused by the COVID-19 pandemic, which introduced new challenges to continuing TB testing and treatment. According to WHO estimates, 32,000 people in Ukraine developed TB in 2020. However, the number of people in Ukraine with TB who went undiagnosed, untreated, or uncounted (what is known as “missing” cases) increased by 40% over 2019.
WHO also notes that globally, because of the pandemic, there was a 15% decline in people enrolled in treatment for drug-resistant TB. And at the same time, the number of people on preventive treatment dropped, as did TB vaccine coverage and investment in TB services.
Humanitarian Crises Exacerbate Tuberculosis
Ukraine is not the only country dealing simultaneously with a humanitarian crisis and high incidence of TB. Central African Republic, Democratic Republic of the Congo, Ethiopia, Mozambique, Myanmar, Nigeria, and Pakistan, which are experiencing both conflict and humanitarian emergencies, all make the list of the 30 countries with the highest TB burden. During a humanitarian crisis, TB patients often struggle to continue their treatment, which is necessary to maintain their health, remain noncontagious, and avoid developing drug resistance.
A child is vaccinated against measles, tuberculosis, and polio in Kalemi, Democratic Republic of the Congo. Photo: Karel Prinsloo/ UNICEF
Maintaining treatment is especially difficult when people are forced to relocate during times of crisis. Displacement can also lead to overcrowding (in shelters, camps, trains, and buses), decreased access to masks and personal protective equipment, and lowered natural immunity to infections (due to fatigue, malnutrition, and stress).
The Case for Investing in Global Efforts to End TB
In 2022, as the world continues to cope with the COVID-19 pandemic as well as a host of other health emergencies, there is an urgent need to invest resources to ramp up the fight against TB and make good on the commitments made by global leaders to end TB. Investment in TB is also an essential element in providing universal health coverage and supporting a stronger global infectious disease prevention network, both of which are crucial in preparing for future health emergencies and ensuring health equity.
In particular, it is imperative that donors continue to support the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Earlier this month, the Global Fund added $30 million to its Emergency Fund, which aims to respond to the devastating impacts that global emergencies have on Global Fund-supported health programs, including those affected by the conflict in Ethiopia’s northwestern Tigray region and by Tropical Storm Ana in Malawi and Mozambique. These additional funds included $15 million to support the continuity of HIV and TB prevention, testing, and treatment services in Ukraine.
In addition, 2022 is a funding replenishment year for the Global Fund, and the organization has called on global leaders to invest $18 billion to get back on track to end HIV, TB, and malaria, accelerate progress toward the Sustainable Development Goals (SDGs), and strengthen health systems to reinforce pandemic preparedness by 2030.
The benefits of ending TB could be profound, but they will require sustained collaboration, commitment, and financial investment. The people affected by this wretched disease deserve better — in Ukraine and around the world.
