GENEVA – On World TB Day, 24 March, the Global Fund is urgently calling for the world to reignite the fight to end tuberculosis (TB) by 2030. The COVID-19 pandemic has upended years of progress in the fight against TB. Deaths from the disease rose for the first time in more than a decade, fueled by a surge in undiagnosed and untreated cases.
“If we fail to step up the fight against TB, we must accept that we are effectively abandoning the 2030 goal to end the disease as a public health threat,” said Peter Sands, Executive Director of the Global Fund. “We must mount a massive effort to diagnose people quickly and get them the necessary treatment. TB is deadly and is the top infectious disease killer after COVID-19.”
TB programs helped the COVID-19 response
In many countries, COVID-19 overwhelmed health systems, lockdowns disrupted service provision, and critical resources were diverted from the fight against HIV, TB and malaria to fight the new pandemic.
But decades of effort fighting TB were not in vain. With the additional resources deployed [ download in English | Français ] countries leveraged some of the best assets in the fight against TB to combat COVID-19. Community health workers, laboratories, diagnostic equipment, disease surveillance systems and other TB investments put in place over the years gave countries a leg up in the fight against the new pandemic.
The Global Fund partnership has also supported the roll-out of bidirectional testing, where people are simultaneously screened and tested for TB and COVID-19. In the future, it is likely this approach will be expanded to other diseases.
“Community health workers are on the front line of detecting and treating diseases, whether that’s for COVID-19 or TB, HIV or malaria,” said Dr. Eliud Wandwalo, the Global Fund’s head of tuberculosis programs. “They are trusted members of the community and we have seen their critical role during the COVID-19 pandemic.”
Drug-resistant TB
In most cases, TB is treatable and curable. However, standard TB treatment requires up to six months of drugs that can cause nausea, vomiting and stomach pain. The duration and side effects drive some people to abandon their treatment, which in some cases can lead to drug resistance – when TB bacteria is resistant to at least one of the main TB drugs.
Drug-resistant TB is part of the growing challenge of antimicrobial-resistant superbugs that do not respond to existing medications, resulting in fewer treatment options and increasing death rates for illnesses that would ordinarily be curable – including TB. Drug-resistant TB now accounts for one-third of the world’s deaths from antimicrobial resistance.
Because of stretched resources during the COVID-19 pandemic, between 2019 and 2020, the number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by a staggering 19%; those on treatment for extensively drug-resistant TB registered an even bigger drop of 37%; and the number of HIV-positive TB patients on antiretroviral treatment as well as TB treatment dropped by 16%. Overall, around 1 million fewer people with TB were treated in 2020, in countries where the Global Fund invests, compared with 2019.
The Global Fund is the largest external source of financing for drug-resistant TB in low- and middle-income countries, working with partners to support the introduction of new drugs that provide better and faster treatment. The amount of funding for drug-resistant TB available through the Global Fund has more than tripled over the last six years.
Rapid response to TB in Ukraine
According to the World Health Organization (WHO), in 2020, 30 countries accounted for 86% of new TB cases around the world. Eight countries account for two-thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
In the European region, Ukraine is one of the countries with a high prevalence of TB. The disease re-emerged as a public health challenge in the 1990s. According to WHO, while new cases have significantly decreased over the last 15 years, TB prevalence, as well as TB deaths, remain high in the country. Drug-resistant TB also remains a public health threat in Ukraine. Over the last two decades, the Global Fund has invested more than US$850 million in Ukraine for HIV and TB testing, prevention and treatment programs and to fight COVID-19.
“We are extremely concerned for the health of people on HIV and TB treatment in Ukraine who are fleeing conflict in very stressful situations,” said Sands. “The Global Fund is fast-tracking US$15 million in emergency funds and working with partners in Ukraine and some of the nearby countries to ensure patients in their programs continue to get the treatment and support they need to be healthy.”
The Global Fund Replenishment campaign
Last month, the Global Fund launched its Seventh Replenishment campaign, aiming to raise at least US$18 billion to fight TB, HIV and malaria, build stronger systems for health and reinforce pandemic preparedness. In the countries where the Global Fund invests, the largest increase in projected funding needs is for TB care.
The Global Fund is the leading international funder of TB programs – providing 77% of all international financing for the disease. From January 2021, the Global Fund has increased TB grants by 24% on average, and the partnership is committed to deploying more than US$2 billion to fight the disease over the next three years.
To get the world back on track toward ending TB as a public health threat by 2030, urgent efforts are needed to prevent and treat TB, including a renewed focus on finding “missing” people with TB and successfully treating them.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
