There are many roadblocks along the path to getting rid of TB worldwide. These include addressing drug-resistant strains, low awareness about the disease, funding, and engaging the private sector to help eliminate the disease.
Overcoming these obstacles is crucial for a TB-free future. Let’s look at the top issues preventing TB from becoming a thing of the past.
1. Multidrug-resistant tuberculosis (MDR-TB) and Extensively drug-resistant TB (XDR TB) on the rise
Multidrug-resistant tuberculosis (MDR TB)
Multidrug-resistant tuberculosis (MDR TB) is a grave danger to public health because strains of mycobacterium tuberculosis become resistant to the two drugs most commonly used to treat TB, isoniazid and rifampicin. This form of TB is practically incurable by standard treatment, leading to increased morbidity and mortality rates. There were about 450,000 MDR TB cases globally in 2021 (WHO data).
Extensively Drug-Resistant Tuberculosis (XDR TB)
Apart from MDR TB, there is the danger of extensively drug-resistant TB (XDR TB). This type of infection is resistant to the most powerful drugs used against TB. While XDR TB is rare, infected patients are left without many treatment options or are treated with medication that is not as effective.
The biggest risk of developing XDR TB is for people with HIV or other immunocompromising health conditions. This group of people is also at a higher risk of dying from the infection.
2. Myths in developed countries that TB is no big deal
In many parts of the world, people are not well-informed about TB, its symptoms, prevention, and treatment, which leads to delayed diagnosis and the further spread of the disease.
- The perception might stem from the fact that TB is more prevalent in low- and middle-income countries, leading some in developed nations to believe it is not a significant concern.
- Advanced healthcare systems and effective treatments in developed countries may create a false sense of security. After all, when people are diagnosed and treated early, and preventive measures are in place, many communities do not see many TB cases, leading them to think it may not be a huge concern.
3. Limited funding for TB-related awareness initiatives
There is a lack of funding for (TB) elimination efforts compared to cancer and heart disease.
For the End TB 2023-2030 plan, WHO estimated that US $249.98 billion would be needed.
However, funding has been significantly lower than the amount required. For example, WHO notes that in 2020, global spending on TB-related services dropped (for the first time since 2016) to $5.3 billion—an 8.7% reduction from 2019-2020.
This can be due to factors like:
- People in developed countries may think of TB as a thing of the past, which means there is minimal urgency or prioritization for this infectious disease.
- TB mainly affects low- to middle-income countries in Asia and Africa. These regions tend to receive less attention and resources.
4. Inadequate disease surveillance and reporting
In India, for example, which has the highest number of TB cases and deaths, 70% of healthcare is provided by a fragmented private sector. Without universal healthcare, it is challenging to ensure accurate and early diagnosis and reporting, poor patient compliance with treatment protocols (since TB treatment takes months), and a high drop-out rate.
5. Poor living conditions
Overcrowded living conditions and poor sanitation, often seen in developing countries and among refugees or homeless populations, facilitate the spread of the TB bacteria.
Without nutrition, adequate living conditions, and effective and easy access to affordable healthcare, many communities are at a higher risk of getting a bacterial infection like TB and spreading the disease. Overcrowding and poorly ventilated work or home environments make things worse.
6. A lack of effective vaccination
Currently, the TB vaccine in circulation is the Bacillus Calmette-Guérin (BCG). Developed over 100 years ago, the vaccine effectively prevents 120,000 deaths in children each year.
However, to eradicate TB, we need to address issues with the BCG vaccine:
- It does not provide lifelong immunity against tuberculosis.
- It does not protect against severe TB.
- BCG is not indicated for people with HIV or other immunocompromised conditions. However, this group of individuals is at a higher risk of getting severe TB.
- It is not effective against adult pulmonary TB and the infection in adolescents.
- It is Ineffective against drug-resistant strains of TB.
However, developing a new vaccine has proved challenging. While a few TB vaccine candidates are in trials, none have been approved for widespread use.