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Unexpected challenges to end tuberculosis

M Tadolini(1,2) M C B Raviglione(3)

1:Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; 2:Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, 40138, Italy; 3:Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, 20122, Italy

The global burden of tuberculosis (TB) remains high with a WHO estimated incidence of 9.9 million cases in 2020. This represents a small decline compared to 2019, continuing the slow downward trend observed since the early 2000s. However, between 2019 and 2020, the estimated number of deaths increased from 1.4 to 1.5 million representing the first ever annual increase since 2005. While there is substantial geographic variation and some success stories exist, the global TB targets are largely off-track

Unprecedented challenges undermining the gains to end TB recently emerged. The first is the COVID-19 pandemic which, from the first trimester of 2020 and throughout multiple waves, disrupted routine health system activities, especially in poorer countries, and diverted human resources, diagnostic and treatment services, research, and investments. Service disruptions and limited access to care resulted in an alarming global drop in TB case notifications and increased TB-related mortality. A second challenge, together with other conflicts, is the Russian invasion of Ukraine which constitutes a major risk of diagnosis and treatment interruptions in a context of high MDR-TB burden. Thirdly, recent evidence from national TB prevalence surveys demonstrates that approximately 50% (range: 36.1-79.7%) of prevalent bacteriologically confirmed TB cases were subclinical. Such cases may contribute to the ongoing transmission of infection. Diagnostic and treatment strategies specifically targeting subclinical TB are therefore necessary.

To end TB in our lifetime, all these challenges call upon streamlined efforts at global and national level, with additional resources, research and investments. 


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