World commits to ending tuberculosis by 2030

World leaders meeting at the UN General Assembly have set the World Health Organisation the ambitious target of eradicating tuberculosis by the end of the decade.

The UN says if countries follow through on their commitments, it will put the world on track to end TB by 2030 and provide life-saving treatment for 45 million people between 2023 and 2027.

The WHO says it needs a better vaccine, but a recent article in the influential Lancet magazine suggests improving nutrition might be the key.

The WHO is governed by member states who set its goals every year at a general assembly and are then expected to fund the program.

Leaders meeting at the UN on September 22 issued a communique reaffirming the commitment to end tuberculosis, a pledge first set down in 2018.

They said they were “deeply concerned” that some of the global targets set at previous UN high-level meetings might not be reached, and were “alarmed by the adverse impact of the COVID-19 pandemic on access to diagnosis and treatment for people affected by tuberculosis,” which the WHO reports has resulted in increases in illness and deaths, and the persistent crisis of drug-resistant and multidrug-resistant tuberculosis.

Explainer: Tuberculosis

Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV and AIDS). This bacterium causes the host to be fatigued, feverish, lose appetite and weight, possible night sweats, a weakened immune system, and can result in death.

The world leaders agreed on a Political Declaration stating, “targets include reaching 90% of people with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB; providing social benefit packages to all people with TB; licensing at least one new TB vaccine; and closing funding gaps for TB implementation and research by 2027.” 

The current global vaccine of choice is Bacille Calmette-Guerin (BCG). Its effectiveness is between 70% and 90% but this varies between adults and children.

But at the same time as the statement was being made at the UN, in the Lancet Global Health, researchers say undernutrition affects an individual’s mortality to TB and they urge authorities to work on increasing the individual’s weight as part of the health care approach.

“Weight gain, particularly in the first 2 months, was associated with a substantially decreased hazard of tuberculosis mortality. Nutritional support needs to be an integral component of patient-centred care to improve treatment outcomes in such settings,” the report states.

It claims an instantaneous risk of death over the treatment period reducing by 13% for a 1% weight gain and by 61% for a 5% weight gain at 2 months.

Does this mean that WHO can kill two birds with one stone: malnutrition and TB (disease prevention)?

It appears unlikely.

The World Health Organisation declared TB to be a “global emergency” 30 years ago.

An article this month in EClinical Medicine from a meta-analysis of 82 articles focussed on preventing TB says in 2021, there were an estimated 10.6 million incident TB cases and 1.6 million TB-related deaths.

“The highest numbers of TB cases were reported in Africa and South-East Asia regions and the vast majority of TB (87%) occurred in 30 high TB-burden countries.”

“Of all investigated preventive treatment options, the isoniazid plus streptomycin regimen was ranked to be the most likely best treatment option to reduce TB incidence among populations at risk of developing TB,” the researcher says in the report.

Isoniazid is a drug utilised to treat, prevent, or stops TB reactivation, but it can also have damaging side effects.  Streptomycin, is an antibiotic.

“This result should be interpreted with caution as it is based on a single old trial that investigated isoniazid plus streptomycin efficacy in preventing TB incidence amongst the study population with residual cavitation but no active TB.

“As TB can be antimicrobial resistant, it can be difficult to help those who have already contracted the disease. Close to half a million infected develop a resistance to medication.”