Recently, Union Minister of Health and Family Welfare Harsh Vardhan acknowledged the impact of COVID-19 on the fight against tuberculosis. He said: “The deadly virus has derailed our painstaking efforts of many decades and diverted scientific attention from many infectious killer diseases like TB.” The minister is right. COVID-19 lockdowns have resulted in a 30 per cent decline in tuberculosis diagnosis and reporting, according to government figures. Researchers estimate that over the next five years, an additional 1.19 million TB cases and 3,61,000 TB deaths may occur in India.
We agree that the pandemic has set back the response to TB, but we believe this is temporary. In the long run, the pandemic provides an unprecedented learning opportunity and opens up possibilities of accelerating our TB elimination endeavour. Here is why.
First, COVID-19 has rattled governments, institutions, and people in a way that no other disease has in modern history. TB is a cousin infectious disease that also spreads through droplets and aerosols, causes respiratory illness, and has a mortality rate of 13 per cent — far worse than the 1.3 per cent for COVID-19. In 2019, TB caused 1.4 million deaths, globally. COVID-19 is set to overtake this figure. In the COVID-19 era, the public health attention and priority which TB and multi-drug resistant TB deserve from local governments and the public will be significantly greater, now that leaders and individuals have realised the devastation an infectious respiratory disease can cause.
Second, masking, social distancing, and tracing have become commonplace practices due to COVID-19. These hold the key to TB elimination as well. Doctors and nurses will be less complacent about these measures, and, over time, the general public will comply more easily with these practices too. Moreover, investments in health systems infrastructure, infection control equipment and personal protection equipment will ensure better airborne infection prevention and control — this will come in handy in the fight against TB.
Third, the COVID-19 experience will boost TB testing at scale using modern tools. There will be increased public acceptance for the sputum test to diagnose TB — like the COVID-19 test, this method also involves testing nasal swabs. More importantly, COVID1-9 has changed the landscape of testing and surveillance. The speed of research on new COVID-19 tests and the scale at which testing was applied are lessons to be learned by TB programmes. We are excited to learn about the “bi-directional” TB and COVID-19 testing launched recently under the Health Minister’s leadership. With PCR (polymerase chain reaction) technology and the next-generation sequencing technology as the backbone of diagnostics, tests for COVID-19, TB and other respiratory diseases can be packaged together at low cost and high volume at community-based screening sites. Greater identification of cases will lead to more persons being isolated and treated, and less long-term transmission of TB.
Fourth, the success of various COVID-19 vaccine platforms and the speed at which the vaccine has been brought to the market gives tremendous hope for TB vaccine candidates, which have been on the slow-track for decades. Governments, donors and affected communities will ask: “If we can have a vaccine for COVID-19 in such a short time, why can’t we do the same for TB?” Fast-tracking of research, advance purchasing, and risk sharing by countries witnessed during the pandemic could apply to the TB vaccine. Researchers on the COVID-19 vaccine race can quickly pivot using their platforms to TB.
Lastly, while national and international leaders have seen TB as a priority area, many state and local leaders in India have not prioritised TB elimination. But COVID-19 has taught us to prioritise public health as much as curative and preventive health. Investing more in TB elimination right now is more important than ever before.
So, to the respected health minister and other leaders, we say: Yes, the fight against TB has lost ground due to the COVID-19 pandemic, but only in the short term. In the long term, COVID-19 is likely to expedite the trajectory of TB elimination. We now readily accept masking, physical distancing, tracing, testing, and vaccinating. Let us not squander this window of opportunity that has been opened for the elimination of TB.
This article first appeared in the print edition on December 18, 2020 under the title ‘Contagions in the air’. Jain is at Emory University, Rollins School of Public Health, USA, and Sahu is with Stop TB Partnership, Geneva.