What is tuberculosis and why are deaths rising?

"The struggle to end TB is not just a struggle against a single disease. It’s also the struggle to end poverty, inequity, unsafe housing, discrimination and stigma, and to extend social protection and universal health coverage."

This is what World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said in the WHO's Global Tuberculosis report 2021.

"If the pandemic has taught us anything, it’s that health is a human right, not a luxury for those who can afford it."

World TB Day is held on March 24 each year with the aim of raising awareness of this deadly disease. In 2022, the WHO is organizing a special high-level virtual event around the theme of "Invest to End TB. Save Lives".

Renewing efforts to overcome TB is particularly crucial because two years of the COVID-19 pandemic has reversed progress towards ending the disease, and achieving the WHO's goals of equitable access to prevention and care in line with Universal Health Coverage.

Deaths from TB have risen during the pandemic - and for the first time in a decade, according to the WHO, with 1.5 million people dying from Tuberculosis in 2020 (of which 214,000 were HIV positive).

Until COVID-19, TB was the main cause of death from a single infectious agent, higher even than HIV/AIDS. Unlike COVID-19, it's a bacterial rather than virus-caused illness.

TB's been around for thousands of years, but the bacteria that causes it - Mycobacterium tuberculosis - was only discovered in 1882 by Dr Robert Koch. It's spread when people who are ill expel the bacteria into the air, through coughing or sneezing.

"Both TB and COVID-19 primarily affect the lungs," says Dr. Tereze Kasaeva, Director of the WHO's Global Tuberculosis Programme in the latest WHO Science in 5 video.

"Patients with tuberculosis, in cases where they've got COVID-19, will have more severe COVID-19 and the risk of less successful treatment is higher."

Symptoms can be similar to COVID-19 and include coughing (sometimes with blood), fever, night sweats, or weight loss.

One in four people in the world is infected with the bacteria, meaning a higher risk of developing disease, according to the WHO, but not everyone with it becomes ill.

Most cases (90%) of TB occur in adults - and those with compromised immune systems, such as people with HIV, diabetes, or malnutrition, have a higher risk of becoming ill.

It occurs in all parts of world, but some places have a higher burden of disease. In 2020, two-thirds of new cases were in just eight countries: India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

According to the WHO, the burden of HIV-associated TB is highest in Africa, where 85% of TB patients in 2020 had a documented HIV test result.

It can be successfully treated with a 6-month course of drugs, but diagnosis has dropped due to the healthcare disruption of the pandemic, says Dr. Kasaeva.

"We can see significant drops in TB diagnosis notification and it means that access is limited... People are not receiving timely life-saving treatment and the transmission of the infection is continued."

The only licensed vaccine for prevention of Tuberculosis disease - the bacille Calmette-Guérin or BCG - was developed 100 years ago, and prevents severe forms of TB in children, says the WHO.

As yet, there is no vaccine effective in preventing TB disease in adults, but results from a Phase II trial of the M72/AS01E candidate have shown promise.

Dr. Kasaeva encourages those with Tuberculosis to follow their doctor's advice during the pandemic, as well as the principles of good hygiene, ventilation, mask wearing and cough etiquette.

"Get yourself tested for both TB and COVID-19 if you have symptoms like coughing, high fever, and difficulties in breathing... You should be tested for TB if you have history in your family or close contacts with Tuberculosis and you've been tested with a TB infection."

The World Economic Forum launched the Ending Workplace TB (EWTB) initiative at the Annual Meeting in January 2020 to bring new private sector partners to the fight against TB.

Up to 50% of cases of some infectious diseases originate in the workplace, research suggests. Breaking the chains of TB transmission in workplaces could have a major impact on ending TB.

EWTB identifies four core challenges that are central to the ongoing TB epidemic and particularly relevant to employers:

1. Stopping community transmission by raising awareness and working in the community to stop infection and spread
2. Lowering patient costs by working with companies to not only offer, but encourage employers to take sick leave when relevant and benefit from phased return-to-work policies
3. Accessing healthcare services by establishing or connecting with screening, referral and support services in the workplace
4. Reducing stigma by working with technical partners to identify and overcome barriers to speaking about or addressing TB in the workplace

Watch the WHO's Science in 5: Tuberculosis and COVID-19 here: