How beating TB today better prepares us for pandemics tomorrow

In stark contrast with the kind of attention COVID-19 sparked, the global fight against tuberculosis gets so little attention that we’re looking at a 100-year timescale. After being overtaken by COVID-19 in 2021, early indications are that TB killed more people in 2022 than any other infectious disease.

In 2021, WHO estimated that 10.6 million people got infected with TB and killed nearly 1.6 million individuals, mostly in low- and middle-income countries. Yet, we are continuing to use a century-old vaccine — the BCG — that is largely ineffective in adults, and technologies such as smear microscopy that misses over half of all people with TB. What is lacking is any real sense of urgency from the global community to tackle it. Because TB primarily affects people in the global south, as with other diseases such as malaria or HIV, it seems invisible to people and institutions in the global north.

The COVID-19 pandemic delivered a massive hit to nearly all areas of global health. Subsequent inflation and rising costs of staple goods has seen hundreds of millions of additional people fall into poverty. But progress against TB was hit particularly hard. One of the reasons was that TB programs were so well suited to taking on COVID-19 that they were majorly disrupted by the pandemic. As a result, the fight against TB has been set back to levels last seen in 2012, with funding falling by nearly 10%.

Yet, despite the fundamental role that TB services played in most countries at the peak of the COVID-19 pandemic, and the enormous impact of the disease, TB is almost entirely excluded from conversations around pandemic prevention, preparedness, and response, or PPPR. There was no reference to TB at all in the zero draft of the new pandemic accord. Not only is this an unconscionable abandonment of the 10 million people worldwide who contract TB every year, it is also a terrible missed opportunity.

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