End TB: The clock is ticking

This article first appeared in theprint.in.

Preventable and treatable? Yes, tuberculosis is both. With this principle in mind, the World Health Organization announced the “End TB Strategy” in 2014, which aims to to reduce TB deaths by 95% and cut its incidence by 90% between 2015 and 2035. Seven years later, are we on track to achieve those targets?

The statistics suggest otherwise. The WHO reports that TB is still amongst the top ten killers worldwide and the leading cause among infectious diseases. TB claimed an estimated 1.4 million lives in 2019, including 240,000 HIV-positive people. Across the globe, the incidence of TB fell by 9% cumulatively between 2015-2019, but this is less than half of the “End TB Strategy” milestone of a 20% reduction between 2015 and 2020. Worryingly, multi-drug resistant TB has emerged as a major threat to global health, with a 10% increase in cases seen between 2018 and 2019. Presently, eight countries account for two-thirds of new TB cases, with India at the head of a group which also includes Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

Slow progress

Funding, the main sword with which to fight TB, is expected to be less than 50% of the targeted amounts needed for TB research, prevention, diagnosis, treatment and care in 2018-2022. How is it possible to raise our fight against this public health scourge when we consider it is low- and middle-income countries that account for a majority of the cases.

The COVID-19 pandemic further threatens to reverse what progress we have made against this global disease. The WHO’s Global TB report 2020 states that the economic impact of COVID-19 could worsen two main determinants of TB incidence: GDP per capita and undernutrition. Two modelling studies suggest that in the aftermath of COVID-19, the progress made to control the disease could be reversed, with annual global TB deaths rising to levels last seen in 2015 or even 2012. The data further suggests that the number of people developing TB could increase by more than 1 million per year in the period 2020–2025.

As TB threatens to return with a vengeance, it’s time to roll up our sleeves and meet the threat head on. Multi-sectoral collaborations are clearly an imperative in leading the way forward. A mix of biomedical, public health and socioeconomic interventions, combined with research and innovation, will create a portfolio strong enough to tackle the menace. However, given the constraints in terms of funding, trained human resources and availability of infrastructure to conduct tests and support TB care and clinical decisions, mainly in low resource settings, technology and digital health will have to be the torchbearer.

With 8.4 billion people now having access to a mobile phone and 47% internet coverage across the globe, mobile health (mHealth) and electronic health (eHealth) could be real game-changers, providing solutions and avenues for action on aspects of TB prevention, care and control. This should come as relief both for TB patients and the health professionals treating them.

The Global Task Force on digital health for TB has identified four areas in which information communication technology can be applied: patient care; surveillance and monitoring; programmatic management; and eLearning. There have been remarkable examples across the globe that provide stron evidence of the success of digital health in each of the above four domains. In Kenya, cash transfers are being done through mobile banking to support MDR-TB patients in their treatment. In Swaziland, health managers can see maps of treatment facilities and infer how they relate to the location of MDR TB patients and treatment supporters’ homes. QuanTB is a software-based program that creates a dashboard for drug forecasting and avoids drug inventories running out.

Global initiatives

Across the world, there are several other initiatives being taken to seize every opportunity that technology presents to empower people affected by TB and to strengthen the community and health systems that drive the responses. Keeping in mind the importance of digital health, earlier this year The Stop TB Partnership, hosted by UNOPS, launched a Digital Health Technology Hub (DHT Hub) – a unifying virtual platform that brings together the organization’s expertise and work in the digital health technology space.

The World Economic Forum’s Centre for the Fourth Industrial Revolution in India, under its Health Project – Fourth Industrial Revolution for Sustainable Transformation of Healthcare (FIRST), will also be working with a coalition of partners from government, academia, industry and civil society to conceptualise the evidence-based implementation and impact measurement frameworks to deploy emerging technologies like AI, ML and blockchain in early detection, patient adherence and TB care in India.

It is time to catapult the TB response on the fulcrum of technology throughout the TB cascade of care, not only to maintain essential TB services, but also to improve TB case detection, adherence to treatment and treatment outcomes.

The theme of World TB Day 2021 – “The Clock is Ticking” – conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders seven years ago. The End TB strategy gave us a vision – we should now have the resolve to transform our commitments into actions.