The ‘World Health Organization (WHO)‘ publishes the “Global Tuberculosis Report (GTR)” annually. The report provides a comprehensive and up-to-date assessment of the TB epidemic and progress in the prevention, diagnosis and treatment of the disease at global, regional, and country levels, which is done in the context of Global TB commitments, strategies and targets. WHO has published a Global TB Report every year since 1997.
About the Global TB Report 2022
The Global Tuberculosis Report 2022 was released on 27 October 2022 by the World Health Organization.
This 2022 edition of the report is based primarily on data gathered by WHO from the National Ministries of Health in annual rounds of data collection.
In the 2022 report, 202 countries and territories with over 99% of the global population and TB cases reported data. The data are collected from the National TB Programmes (NTPs) or the national entity responsible for TB surveillance.
Key Highlights of the Global TB Report 2022
The COVID-19 pandemic continues to have an unfavourable impact on access to TB diagnosis and treatment and the burden of TB disease. Progress made up to 2019 has slowed, stalled or reversed, and Global TB targets are off track. The most immediate impact was a considerable global drop in the reported number of people newly diagnosed with TB.
Number of people diagnosed with TB
From a peak of 7.1 million in 2019, the reported number of people newly diagnosed with TB dropped to 5.8 million in 2020, dropping by 18%, back to the level last seen in 2012.
In 2021, there was a partial recovery in the reported number of people diagnosed with TB to 6.4 million (the level of 2016-2017).
The three countries that accounted for the most reduction in 2020 in the reported number of people newly diagnosed with TB were India, Indonesia, and the Philippines (67% of the Global total). They made a partial recovery in 2021 but still accounted for 60% of the global reduction compared with 2019.
The other high-burden countries with large relative year-to-year reductions, more than 20%, included Bangladesh (2020), Myanmar (2020 and 2021), Lesotho (2020 and 2021), Mongolia (2021), and Vietnam (2021).
Reductions in the reported number of people diagnosed with TB in 2020 and 2021 suggested that the number of people with undiagnosed and untreated TB has risen, resulting in increased TB deaths and more community transmission of infection and then, with some lag-time, increased numbers of people developing TB.
Globally, the estimated number of deaths from TB increased between 2019 and 2021, reversing years of decline between 2005 and 2019.
In 2021, there were an estimated 1.4 million deaths from TB among HIV-negative people and 1,87,000 deaths among HIV-positive people, for a combined total of 1.6 million. This was up from the best estimates of 1.5 million in 2020 and 1.4 million in 2019 and back to the level of 2017. The net reduction from 2015 to 2021 was 5.9%, about one-sixth of the way to the first milestone of the WHO’s End TB Strategy.
An estimated 10.6 million people fell ill with TB in 2021, an increase of 4.5% from 10.1 million in 2020.
The TB incidence rate (new cases per 1,00,000 population per year) rose by 3.6% between 2020 and 2021, reversing declines of about 2% per year for most of the previous two decades. The net reduction from 2015 to 2021 was 10%, only halfway to the first milestone of the End TB Strategy.
Estimating the TB disease burden during the COVID-19 pandemic is more challenging than previously and relies heavily on the country and region-specific dynamic models for low and middle-income countries (LMICs).
The new national population-based surveys of TB disease and up-to-date cause of death data from national vital registration systems of high quality and coverage are needed for more accurate estimation in the wake of the pandemic.
The burden of drug-resistant TB (DR-TB) is also estimated to have increased between 2020 and 2021, with 4,50,000 new cases of rifampicin-resistant TB (RR-TB) in 2021.
Globally, there were an estimated 4,50,000 incident cases, up 3.1% from 4,37,000 in 2020. The main reason for this increase is an overall increase in TB incidence from 2020 to 2021, estimated to have occurred due to the COVID-19 pandemic’s impact on TB detection.
Another negative impact on TB during the COVID-19 pandemic includes a drop between 2019 and 2020 in the number of people provided with treatment for RR-TB and multidrug-resistant TB (MDR-TB). It dropped by 17% from 1,81,533 in 2019 to 1,50,469 in 2020 (about 1 in 3 of those needed), with a partial recovery of 7.5% to 1,61,746 in 2021.
An estimated 1,91,000 deaths occurred due to MDR/RR-TB in 2021.
Financing for TB prevention
Another negative impact on TB during the COVID-19 pandemic was a decline in global spending on essential TB services, from USD 6.0 billion in 2019 to USD 5.4 billion in 2021, less than half of what is needed.
WHO started annual monitoring of funding for TB prevention, diagnostic and treatment services based on data reported by National TB Programmes (NTPs) in annual rounds of global TB data collection in 2002.
The Global Plan to End TB (2018–2022) estimated that US$ 9.2 billion was required for TB prevention, diagnostic and treatment services in 128 low-and middle-income countries (LMICs) in 2018, increasing to US$ 15.6 billion in 2021 and US$ 16.1 billion in 2022.
For 2023–2030, a new Global Plan estimates much higher funding needs of USD 15–32 billion per year in low-and middle-income countries (LMICs), which also includes funding for implementing a new TB vaccine after 2027.
Spending on TB prevention, diagnostic and treatment services in LMICs falls far short of the globally estimated need and the UN global target and has declined since 2019.
In 2021, the total spending on TB prevention, diagnostic and treatment services was only US$ 5.4 billion, which is less than half of the amounts estimated to be required in 2020 and 2021 in the current Global Plan (2018–2022) and the global target set at the UN high-level meeting on TB.
Globally, the success rate for people treated for TB in 2020 was 86%, the same level as in 2019, presenting that the quality of care was maintained in the first year of the COVID-19 pandemic.
The Global number of people provided with TB preventive treatment recovered in 2021 to close to 2019 levels and the Global target for provision of treatment to people living with HIV was surpassed.
In the WHO African Region, the impact of COVID-19-related disruptions on the reported number of people newly diagnosed with TB was limited. There was a relatively small decrease of 2.3% from 2019-2020 and an increase in 2021.
Following big falls in 2020, the reported number of people newly diagnosed with TB in 2021 recovered to 2019 levels (or beyond) in five high TB burden nations: Bangladesh, Pakistan, the Congo, Sierra Leone, and Uganda.
The three high-TB burden nations have reached or passed the first milestones of the End TB Strategy for both reductions in TB incidence and TB deaths: Kenya (in 2018), the United Republic of Tanzania (in 2019), and Zambia (in 2021). Ethiopia is very close.
Key Findings about India
In India, the Union Ministry of Health and Family Welfare (MoHFW) has taken note of the Global TB Report 2022, released by WHO on 27 October 2022.
- The MoHFW clarified that India performed far better on primary metrics when compared with other countries over time.
- For the year 2021, India’s TB incidence is 210 per 1,00,000 population compared to the baseline year of 2015 (TB incidence was 256 per lakh population in India).
- There has been an 18% decline which is 7% points better than the global average of 11%.
- In terms of incidence rates (from largest to lowest incidence rates), India was placed at the 36th position.
- India was among the three countries (along with Indonesia and the Philippines) that accounted for most of the reduction in 2020 (67%) of the global and made partial recoveries in 2021.
- In 2021, 82% of the global TB-related deaths among HIV-negative people occurred in the WHO African and South-East Asia regions, in which India alone accounted for 36% of such deaths.
- India (with 28% of cases) was among the eight countries accounting for more than two-thirds (or 69.3%) of the total TB patients count. The other countries include Indonesia (9.2%), China (7.4%), the Philippines (7%), Pakistan (5.8%), Nigeria (4.4%), Bangladesh (3.6%), and the Democratic Republic of Congo (2.9%).
What is Tuberculosis?
Tuberculosis (TB) is an infectious disease caused by bacillus Mycobacterium tuberculosis. The infection can spread when people infected with TB expel bacteria into the air (e.g. by coughing). TB typically affects the lungs (pulmonary TB).
Of the total number of people who develop TB each year, about 90% are adults, with more cases among men than women.
What are the factors attributing to the new TB infection?
The probability of developing TB disease is much higher among people with HIV.
The new TB infection is attributed to risk factors such as undernutrition, diabetes, smoking, and alcohol consumption.
What are global efforts to tackle TB?
• Global Tuberculosis Programme and Report by WHO.
• 1+1 initiative and Multisectoral Accountability Framework for TB by WHO.
• Ending the TB epidemic by 2030 under UN Sustainable Development Goal Target 3.3.
• Moscow Declaration to End TB.
What are India’s initiatives to tackle TB?
• Ni-kshay Poshan Yojana:
The WHO Report notes the crucial role of ‘under-nutrition’ as a contributing factor to the development of active TB disease. In this respect, the TB Programme’s nutrition support scheme, “Ni-Kshay Poshan Yojana“, has proved critical for the vulnerable. This Scheme involves a cash transfer of ₹500 every month to TB patients through a Direct Benefit Transfer Programme.
During 2020 and 2021, India made cash transfers of 89 million dollars (INR 670 crores) to TB patients through Direct Benefit Transfer Programme.
• Pradhan Mantri TB Mukt Bharat Abhiyan:
On 9 September 2022, the Honourable President of India launched a first-of-its-kind initiative, “Pradhan Mantri TB Mukt Bharat Abhiyan”, to provide additional nutritional support to those on TB treatment, through contributions from the community, including individuals and organisations. It’s an initiative to accelerate the country’s progress toward TB elimination by 2025.
Till the end of October 2022, around 40,492 donors have come forward to support over 10,45,269 patients across the country.
• Ni-kshay Mitra Initiative:
The Nikhay Mitra Initiative provides community support to TB patients by encouraging citizens to adopt one or more patients.
It is to ensure additional diagnostic, nutritional, and vocational support to those on TB treatment.
Ni-kshay Mitra (Donor) are those, who can support by adopting health facilities (for the individual donor), blocks/urban wards/districts/states for accelerating response against TB to complement government efforts.
Source: World Health Organisation