WHO Global TB Report 2022: Impact of the COVID-19 pandemic on the global tuberculosis situation

On October 27, 2022, the WHO published the Global Tuberculosis Report 2022, which annually presents global developments and trends in tuberculosis (TB) from the previous year. The report contains data from 202 different countries on regional epidemiological developments from 2021 and highlights TB management in the areas of prevention, diagnosis and treatment.

The COVID-19 pandemic has posed enormous challenges to healthcare systems around the world over the past three years. Now the already expected negative impact of the pandemic on the global TB situation is becoming apparent: Progress on global TB targets towards elimination has been slowed and in some cases even reversed.

The most significant pandemic-related effect was a decline in the number of TB cases reported worldwide - from almost 7 million reported cases in 2019, the number fell temporarily to 5.8 million in 2020. A slight increase to 6.4 million newly reported cases was recorded again in 2021.

However, this figure falls far short of the actual number of cases, which the WHO estimated at 10.6 million worldwide in 2021. The incidence of TB thus recorded an increase of just under 5% compared to the previous year - an upward trend that ends the decline in case numbers over the last two decades.

The largest decline in case detection during the pandemic was seen in India, Indonesia and the Philippines; at the same time, these three high-incidence countries also recorded the largest rebound last year. In contrast, the WHO Africa region recorded only a slight drop in reported TB case numbers. Due to the overall high difference between the estimated number of new TB cases and those actually reported worldwide, a large proportion of those affected remain undetected and therefore without access to adequate treatment. This can result in an increased infection rate, which is why a further increase in the number of cases is expected in the coming years.

At the same time, a large number of untreated cases can also cause an increase in mortality. TB mortality was already on the rise in 2019. In 2021, the number of deaths rose further to an estimated 1.6 million, reaching the level of 2017. Looking at the overall trend from 2015 to 2021, TB mortality decreased by a total of 6%. The targets of the WHO End TB Strategy have therefore been missed by a wide margin.

Furthermore, the WHO reports a 6% increase in reported TB cases with complex resistance (rifampicin resistance (RR) / multidrug resistance (MDR)) to just under 167,000 in 2021. Of these, the vast majority (just under 160,000) of those affected received MDR therapy, an increase of 8% compared to the previous year. However, the number of MDR/RR-TB cases worldwide is estimated at 450,000, which shows that the vast majority are neither diagnosed nor treated and can therefore contribute to the spread of the disease.

One of the most positive developments is the level of global treatment success, which remained constant at 86% across countries in 2019 and 2020 despite the pandemic. The global trend is therefore stable and the WHO's declared target of 90% treatment success no longer seems far away.

The global number of people receiving preventive TB treatment has returned to pre-pandemic levels in 2021 at 3.5 million. Global funding to combat TB declined to 5.4 billion US dollars and only reached just under half of the financial resources actually required.

Conclusion: The focus on the COVID-19 pandemic has marginalized the prevention, case finding and care of tuberculosis financially, organizationally and ultimately also in the awareness of decision-makers in the healthcare systems. The negative effects are reflected in an increase in TB incidence and mortality. In the future, tuberculosis must regain more attention globally in order to achieve the goals of the End TB Strategy. The financial and human resources planned worldwide must be used urgently to reverse this worrying trend.