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Africa: Global Fund And Stop TB Step Up Collaboration To Fight Tuberculosis, The Biggest Infectious Disease Killer

Geneva — The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the Stop TB Partnership yesterday signed a new collaboration framework with the aim of increasing momentum towards ending tuberculosis (TB) in low- and middle-income countries by 2030.

The oldest pandemic afflicting humanity, TB is the leading infectious disease killer globally and one of the most common causes of death among people living with HIV. The Global Fund provides 76% of all international financing for TB, while the Stop TB Partnership aligns more than 2000 partner organizations all over the world to lead global advocacy, high-level political engagement in TB response, support of communities and people affected by TB, address rights and gender, and introduce new innovations and new tools to end TB.

"The Stop TB Partnership and the Global Fund share a common commitment and vision of a world free from TB, where universal health coverage is implemented and where the Sustainable Development Goals set by the United Nations are achieved," said Lucica Ditiu, Executive Director of the Stop TB Partnership. "We are seeing unprecedented determination and leadership across affected countries to beat this terrible disease, we have a large number of new innovations to prevent, diagnose and treat TB and the most vibrant civil society, communities networks and organizations, so we cannot and we will not stop now. We miss the funding to go full speed ahead, but we will not give up because we are closer than ever to decisive progress by 2030."

"TB is a formidable adversary, but one we know how to defeat," said Peter Sands, Executive Director of the Global Fund. "New advancements in TB prevention, diagnosis and treatment, including innovative tools such as mobile diagnostic units, AI capabilities in screening and testing, as well as shorter treatment regimens, are redefining the way we fight TB now and in the future, bringing new hope. By working even more closely with the Stop TB Partnership, we will scale up the use of these tools and get significant reductions in their price to steepen our trajectory towards ending TB."

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Under the new four-year non-financial agreement, the Global Fund and Stop TB commit to increasing their collaboration on a wide spectrum of advocacy, policy, technical and programmatic areas. A top priority set in the agreement is to support countries to diagnose early and treat all people with TB, including drug-susceptible TB and drug-resistant TB, to continue the work in breaking the gender- and human rights-related barriers that prevent people with TB accessing the services they need and to address TB stigma.

Another key objective is to boost TB preventive treatment through improved access to quality-assured, affordable medicines and diagnostics, as well as by driving innovation and accelerating new product introduction.

As per the new agreement, the two organizations will also continue to work on strengthening critical elements of health systems in the affected countries: supporting community health workers, improving access to the latest WHO-recommended diagnosis, enhancing use of data for decision-making, strengthening supply chains and pursuing integrated approaches, including through primary health care, to enable the delivery of critical services to people with all forms of TB.

The new agreement comes as the latest figures released by the World Health Organization in the Global Tuberculosis Report 2024 highlight mixed progress in the global fight against TB. Although TB deaths are falling and access to treatment is up persistent challenges remain, including increasing TB incidence, no progress on access to rapid molecular diagnosis and drug-resistant tuberculosis diagnosis and treatment, as well as the impact of conflict, displacement, undernutrition, climate change and poverty.

TB Reclaims Title Of Deadliest Infectious Disease. That's An 'outrage' Says WHO

The ancient scourge of tuberculosis for years was the deadliest infectious disease. Then SARS-CoV-2 came along and grabbed the notorious title of #1 killer: In 2020, COVID-19 was responsible for 3.5 million deaths worldwide vs 1.5 million for TB.The 2024 Global Tuberculosis Report, published last week by the World Health Organization, puts TB back in the top slot with 1.25 million deaths in 2023 compared to 320,000 COVID-19 deaths. There's also been an increase of hundreds of thousands of new TB cases in 2023 compared to the year prior.

The 1.25 million TB deaths in 2023 is down from 2022's number of 1.32 million (which that year was second to the COVID toll). But it's still indefensibly high, say public health leaders.

"The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it," said Tedros Adhanom Ghebreyesus, WHO director-general, in a statement issued on October 29.

According to the report, approximately 8.2 million people were newly diagnosed with TB in 2023 — the highest number since WHO began global TB monitoring in 1995 and a "notable increase" from 7.5 million people newly diagnosed in 2022.

TB sleuths are trying to figure out the reasons behind the increase. Anand Date, global TB branch chief at the Centers for Disease Control and Prevention, says population growth may account for the increase in cases last year -- and that it may take until the 2024 to find out if that is so or if the leap in 2023 reflects an undercount of annual TB totals during the pandemic.

"Disruptions to TB programs during the height of the pandemic led to more people going undiagnosed and untreated for TB. [And] guidance to shelter in place may have also limited the spread of TB, says Yogan Pillay, who heads efforts to improve TB program delivery at the Bill and Melinda Gates Foundation (which is a funder of NPR and this blog).

COVID-19 did trigger a new setback in the effort to control TB. But most of the reasons the infection persists are frustratingly well-known, says Lucica Ditiu, executive director of the Stop TB Partnership. There's too little money for research, treatment. And patient care needs. And there's stigma that can keep the most common victims of TB, impoverished people including migrants and sex workers, from seeking help or being offered treatment.

In addition, health conditions like malnutrition, diabetes and smoking that can exacerbate TB and keep medications from being fully effective, says Luke Davis, a TB and HIV specialist at the Yale School of Public Health. "TB is unusual," says Davis, in that most people who are exposed to the bacteria won't progress to infectious TB. Only about 10% do, and they are usually among the world's poorest people often with poor health to begin with, which exacerbates their condition."

So what's the solution?

And that brings us to the Tedros point. The world knows how to vanquish TB — but is not doing a good job.

Money reigns as perhaps the biggest obstacle to conquering tuberculosis. A spokesperson for WHO tells NPR: "Compared with global funding targets for TB set at the 2023 U.N. High-level meeting on TB, there are large funding shortfalls for TB research as well as prevention, detection and treatment services. To close these gaps, more funding is needed from both domestic sources in the countries most impacted by TB and from international donors."

Global funding for TB prevention and care decreased in 2023 from $6 billion in the three previous years to $5.7 billion and remains far below the yearly target of $22 billion, according to WHO.

What would more money bring? WHO cites expanded rapid diagnostic testing as critical. Then treatment can start sooner. And people wouldn't have to travel long distances to a clinic then wait for days for the results.

Increased funding would also help reimburse families for lost wages and food and travel expenses incurred as they go for treatment. Those costs keep some patients and their families from seeking care.

The WHO report and other investigations also say that countries burdened by TB also have to step up and spend more money on prevention, diagnosis and treatment. A report by MSF/Doctors Without Borders published last month, for example, found that, only 5 out of 14 countries have adapted their guidelines — based on WHO recommendations -- to initiate TB treatment in children when symptoms strongly indicate TB disease, even if bacteriological tests are negative.

And increased funding would speed up the pace of research says the CDC's Date. Funding for TB research has stagnated at around $1 billion per year, constraining progress, according to WHO. The target at the U.N. Meeting: $5 billion per year by 2027. "The world also has the most promising R&D pipeline of new TB tools in decades," says Pillay. "What's needed now is greater investment to deliver on the promise of that pipeline and ensure patients and those at risk of TB have affordable and equitable access to these tools when they are available."

Vaccines in the works

Pillay says there are more than a dozen TB vaccine candidates in clinical trials, including one whose late stage (stage 3) clinical trial is sponsored by the Gates Medical Research Institute. The trial began recruiting patients last March. That vaccine candidate is called M72/AS01E and if proven effective would be the first new TB vaccine in 100 years. The lone TB vaccine available now is not predictably effective in adults, and can cause a false positive result on TB skin tests.

But even an effective vaccine won't do that much good if there aren't funds to purchase it for countries impacted by TB. Janeen Madan Keller, deputy director of the Global Health Policy Program at the Center for Global Development, based in Washington, D.C., says that while Gavi, The Vaccine Alliance, pays for [a variety of] vaccines in some of the poorest countries such as Afghanistan, Burundi and the Democratic Republic of the Congo, some countries with high rates of TB are middle income countries, like Indonesia, and no longer eligible for support. Ahead of a TB vaccine's approval, says Keller, there needs to be a better match of policy and funding.

"Often it seems that when we find a way to help vanquish TB," says Lucica Ditiu, "we also find another barrier."

Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health. Find her on X: @fkritz

Copyright 2024 NPR

TB--the Silent Killer Crossing Our Border

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Open borders allow deadly narcotics and criminal gangs to invade our country. But there's a silent killer also making its way across the border: tuberculosis.

America's woke public health authorities are more concerned with equity -- redistributing health resources among racial groups -- than with keeping a disease the U.S. Once nearly eradicated from becoming a threat again.

Reported cases of TB shot up 34% from 2020 to 2023, according to the Centers for Disease Control and Prevention, and continue to rise. More than three quarters of the cases are foreign-born people who picked up the disease in their home countries or traveling through countries with high TB rates. The TB incidence rate is 60 times higher in Haiti than in the U.S. 

'NOW'S THE TIME': TRUMP VICTORY HAS BIDEN ADMIN BRACING FOR MIGRANT SURGE AT SOUTHERN BORDER

In New York City -- the No. 1 destination for migrants -- the incidence of TB is two and a half times the national average and still rising. 

A staggering 89% of TB patients in the Big Apple are foreign-born. The Flushing/Clearview areas of Queens, Sunset Park, Brooklyn and the Lower East Side of Manhattan are the neighborhoods most affected. The single largest national group with reported TB cases is from China, according to the city's most recent Annual Tuberculosis Summary.

TB is no laughing matter. Globally, it has just overtaken COVID-19 as the biggest infectious disease killer on earth. There is no effective vaccine for it, but most cases -- except severely drug-resistant ones -- can be treated with antibiotics, provided they're taken daily without interruption for several months or longer. Not easy.

ILLEGAL CHINESE IMMIGRANT EXPOSED HUNDREDS IN LOUISIANA TO RARE TB STRAIN, STATE SUES MAYORKAS, ICE

Western Europe, Scandinavia and North America are all reporting rising TB rates as migrants from poorer countries -- where TB is common -- arrive. UK health authorities are alerting the public to the distinctive cough that comes with TB. 

In Europe, public health authorities are engaged in a lively debate about how to affordably screen TB carriers and keep them from infecting the local population. Someone can carry latent TB for years, then suddenly, after resettling in a new country, develop active -- and highly contagious -- TB and spread it by coughing and sneezing. 

But in the U.S., the mission-confused CDC is stressing health equity and rushing resources to the "disproportionately affected" groups. That's fine, but how about also shielding Americans from the reemergence of a disease they've largely eliminated? In all the agency's reports, not a word about what's causing the surge in TB: an open border.

Immigrants who enter the country legally and apply for green cards are screened for TB with the interferon-gamma release assay test. Latent carriers are allowed into the country and referred to a local health department for follow-up treatment. It's voluntary and hit-or-miss but better than no screening at all.

Migrants flooding across the border illegally or entering with Biden's new parole app get no screening. Zip.

The CDC is MIA about screening and isolating the infected before they bring the disease to cities and towns across the country. The agency is forgetting its "Control and Prevention" mission.

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Take the case of a Chinese migrant with active drug-resistant TB who crossed the border illegally in April. When her symptoms worsened and she was diagnosed on July 23 as "highly positive," nothing was done to isolate her. Instead, she was shuffled between immigration processing facilities in California and Louisiana, exposing hundreds.

Now Louisiana is suing federal authorities to keep the exposed migrants detained until they are medically cleared. State Attorney General Liz Murrill warns about illegals who are "untested for diseases that can threaten the lives of Louisiana and American citizens." 

Thousands of unaccompanied minors with latent TB are being released into communities across the country, rather than being kept in Health and Human Services shelter facilities for the many months it would take to treat them with a course of antibiotics. 

CDC data show a whopping 42% increase in incidence of TB among children ages 5-14 in one year. 

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On Nov. 1, Sen. Mike Lee (R-Utah) demanded that Homeland Security head Alejandro Mayorkas erect precautions against a disease invasion, warning that TB "is rapidly spreading through the millions of unscreened illegal immigrants released into the interior of the United States."

The number of reported cases this year -- just under 10,000 -- is small but the trend is worrisome. The U.S. Waged a war against TB in the 20th century and won. Americans shouldn't have to surrender to this disease now because of open borders.

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