BECAUSE of the present preoccupation with the pandemic, especially the recent surge, not many are aware that tuberculosis (TB) remains one of the leading causes of death worldwide. In fact, prior to Covid-19, TB was the leading cause of death from a single infectious agent, ranking above HIV/AIDS.
According to the World Health Organization (WHO), about a quarter of the world's population is infected with TB. What is ironic is that the disease is curable and preventable. About 85 percent of people who develop TB can successfully be treated. Infections can also be reduced through multisectoral action to address TB determinants such as poverty, undernutrition, HIV infection, smoking and diabetes. The first step, however, is to track and diagnose the carriers.
In a 2021 report, the WHO noted a large global drop in the number of people newly diagnosed and reported to be with TB. There was an 18-percent decline back to the level of 2012 and far short of the approximately 10 million people who developed TB in 2020. Sixteen countries accounted for 93 percent of this reduction, with India, Indonesia and the Philippines the worst affected.
The Philippines has been tagged as among the high burden countries (HBC). The criteria for inclusion on this list are: the top countries in terms of their estimated absolute number of new (incident) cases, severe burden in terms of the incidence rate (new cases per 100,000 population) and meeting a minimum threshold of 10,000 cases per year for TB and 1,000 new cases per year for HIV-associated TB and rifampicin-resistant TB. There are three WHO global HBC lists: for TB, TB/HIV and multidrug resistant-TB. The Philippines is 1 of 10 in all three.
TB is an old disease and there may be a misconception that it is no longer a burden. This is, of course, farther from the truth as statistics bear out. The probability of developing TB is much higher among people living with HIV and among people affected by risk factors such as undernutrition, diabetes, smoking and alcohol.
TB can affect anyone anywhere but most of those who develop the disease (90 percent) are adults. Without treatment, the mortality rate is high. Over two years, Covid has so far caused 52,135 deaths. According to Dr. Camilo Roa of the Philippine Tuberculosis Society Inc. (PTSI), TB kills 27,000 yearly in the country. The WHO estimated roughly 1.5 million deaths in 2020. Treatment is available for people with TB. Currently, there is no vaccine that is effective in preventing TB in adults. Treatment is the primary form of disease control. For these reasons, an important first step is diagnosis and case detection.
The Philippines is one country where there is a big gap (around 500,000) between notified cases and the best estimates of TB incidence in 2020. Gaps are due to a combination of underreporting of those diagnosed with TB and underdiagnosis (owing to people with TB being unable to access health care or not being diagnosed when they do). Microbiological detection is critical because it allows people to be correctly diagnosed. It is necessary to test for drug resistance so that the most effective treatment regimen can be selected early enough.
While the WHO has a vision of a TB-free world by ending the global epidemic by 2035, its 2021 report admits that progress is off-track. It is even worse in countries like the Philippines that are seriously lagging behind, no thanks to the prioritization of the Covid-19 pandemic.
Ending the pandemic is rightly the priority but the TB fight should remain unabated. Pai, Kasaeva and Swaminathan in The New England Journal of Medicine advocated the establishment of "multisectoral collaborations involving personal, societal and health system interventions." This will require addressing "the social determinants of tuberculosis infection and mortality; reducing stigma and other barriers to seeking care; promoting the use of masks, improved ventilation and other airborne infection-control measures; and ensuring that health care workers have adequate personal protective equipment." The work of the Department of Health and relevant private institutions like the PTSI on this front is daunting. The country must not lose sight of the threat and should address the potential costs of infection and mortality. TB should have a major place in the pandemic preparedness and response agenda.
Benel Dela Paz Lagua was previously executive vice president and chief development officer at the Development Bank of the Philippines. He is an active Finex member and an advocate of risk-based lending for SMEs. The views expressed herein are his own and do not necessarily reflect the opinion of his office as well as of Finex.