Every day, over 4,000 people die across the world from a preventable and curable disease – Tuberculosis (TB). TB has regained the unenviable position of being the world’s most deadly infectious disease, briefly overtaken by COVID-19. Ending the TB epidemic by 2030 is part of the United Nations Sustainable Development Goals (SDGs), which, with less than seven years to go, are far from being achieved. Ending TB and improving health outcomes are important to the contribution of other SDGs not immediately related to health, such as educational attainment, gender equality, reducing inequalities and ensuring equal access to decent work and economic growth. Given the importance of health as an indicator of economic participation and productivity, it is incomprehensible that governments, including the UK, are failing to adequately invest in the nation’s health.
The political priority currently given to TB eradication falls well below what is required. This is reflected in the insufficient allocations of funding at global, regional and national levels for TB, which have failed to achieve the targets set by the first United Nations High-Level Meeting on TB in 2018. As world leaders get ready to convene at the second UN High-Level Meeting on TB on 22 September, the world will be watching to see if commitments to accelerate progress to end TB will be achieved. The UN High-Level Meeting on TB is part of the United Nations General Assembly (UNGA), and will provide a global platform for world leaders to make commitments to ending the TB epidemic by 2030. Given the high-profile nature of UNGA, it is regrettable that the Prime Minister will not be attending UNGA, sparking criticism from the international development sector and demonstrating a lack of political priority for sustainable development for people and the planet.
Governments have a responsibility to prevent the spread of infectious diseases such as TB. The increase in disease burden, humanitarian crises, climate change, globalisation and social mobility mean that the risk of infectious disease transmission and resurgence is increasing, which means that ending the TB epidemic is becoming even more urgent to protect global health security. TB is also a major contributor to antimicrobial resistance (AMR), and is responsible for a third of all global AMR deaths. Universal access to TB services for prevention, diagnosis and treatment will reduce the risk of drug-resistant TB and AMR. As we saw with the COVID-19 pandemic, the attainment of health by people in one country can directly concern and benefit people in other countries, since infectious diseases are not limited by state borders. The growing threat of AMR is a public health challenge for all of us, and addressing the TB epidemic will go a long way towards reducing the AMR threat.
The UK is classed as a low-TB incidence country because there are less than 10 cases per 100,000 of population. Although there has been a significant decline in reported TB cases in England since 2011, small increases have been seen from 2019. Between 2020 and 2021, the number of people with TB in England increased by 7.3%, corresponding to a total of 4,425 people with TB in 2021. Despite an overall decrease in the rates of TB in England over the last 10 years, the rate of decline is slowing, and we are not on track to achieve the SDG target by 2030.
The stigma and financial burden that people affected by TB face is still a major issue, even in the UK, as demonstrated by Fatima’s story. Fatima was a 20-year-old university student when she was diagnosed with multidrug-resistant TB. Fatima describes in her own words the stigma she experienced, both from healthcare workers not wanting to enter her hospital room, and from members of the public considering her an infection risk. Fatima was even fired from her part-time job due to having TB. Fatima’s family did not receive any financial support from the Department of Work and Pensions, to pay for the cost of attending hospital visits, amounting to £650 a week, because TB is not classed as an illness severe enough to receive financial support. Fatima’s experience is a stark example of how TB affects a person’s life and is more than just a physical illness. Fatima is now an advocate for people with TB and is the Affected Community Co-Lead of the UK Academics and Professionals to End TB network.
Low-TB incidence countries like the UK cannot become complacent in their approaches to ending TB domestically and globally. Outbreaks of TB in Llwynhendy, Wales have shown the level of transmissibility of the disease and that health systems and services are not always prepared to manage TB outbreaks; for example, it took over a year before the first person who contracted TB was diagnosed, leading to 31 cases of active TB and 300 cases of latent TB in the same locality. All individuals affected in this outbreak were UK-born, further reinforcing that TB can affect anyone anywhere, and that rich economies are not immune.
Low-TB incidence countries have a responsibility to contribute to ending TB globally, to help reduce inequality and to improve economic productivity. Investment in strengthening health systems and pandemic preparedness response capabilities will not only better respond to disease outbreaks, but will also benefit TB and antimicrobial resistance and are part of the UK Government’s international development priorities on strengthening health systems and ending preventable deaths. Investment to end TB has been identified as one the best investments the world can make, because of the lives that can be saved, the short and long-term economic return on investment, and the wider benefits to society, such as poverty reduction, economic growth and improving human capital.
The UN High-Level Meeting on Tuberculosis in September 2023 will review the global progress made since the 2018 High-Level Meeting on TB and will provide an important opportunity for Member States to contribute to accelerate progress to end the epidemic. The UK has the opportunity to contribute to the global TB response and to help ensure that the outcomes of the meeting are achievable, realistic and fully funded, as recommended by the All Party Parliamentary Group on Global TB in its 2022 report. Health needs to be at the top of the political agenda, as improving health is fundamental to achieving a fairer, more secure and prosperous world for all.
As the TB community and stakeholders prepare for the upcoming UN High-Level Meeting on TB this year, the need for country-level leadership and civil society engagement in being accountable for progress on TB is paramount to end TB by 2030.