TACOMA, Washington — The COVID-19 pandemic has worsened already existing socio-economic and healthcare disparities across the globe, especially in outbreak-prone developing nations. The continued need for COVID-19 research and treatment and the limited capacity of healthcare systems have set back advancements in Tuberculosis (TB) eradication. To better understand this crisis, The Borgen Project spoke with Dr. Michelle Haas, an infectious diseases expert based in Colorado.
How Tuberculosis Spreads
Dr. Haas has cared for people with TB for the past decade and has presented to both national and international authorities on the disease. She describes it as a bacteria that is spread from person to person through aerosolized droplets that can remain in the air for hours. Latent TB is generally not contagious and is the most common form of TB in the U.S. It occurs when the immune system successfully halts the growth of TB bacteria in the body, primarily in the lungs.
Active TB occurs when the immune system is unable to stop the bacteria’s growth. This results in symptoms like severe coughing, which promotes TB transmission. Immunocompromised individuals, like those with HIV, have a higher risk of developing active TB if infected with the bacteria.
In order for a country to begin the path toward TB eradication, it must have good medical diagnostics and easy access to treatment for the entirety of its population, explains Dr. Haas. TB treatment consists of daily medications taken for six to nine months to help stop the transmission and progression of the disease. However, many developing countries lack the healthcare infrastructure to provide such intensive treatment, leaving many infected individuals with little to no medical support.
Challenges Toward Tuberculosis Eradication
The World Health Organization (WHO) reports that more than 95% of global TB cases and deaths occur in low-to-middle-income countries. Dr. Haas explains that the legacy of colonialism and discriminatory policies in public health are part of the reason why more developing countries see higher rates of active TB. For example, the legacy of apartheid in South Africa has marginalized certain racial groups and created unequal access to healthcare and TB services in areas where these groups are concentrated. This leads to delays in TB diagnoses and, consequently, undetected transmission of TB. These same inequalities occur in the U.S. with racial and ethnic minorities making up approximately 88% of TB cases.
In terms of colonial legacies, Dr. Haas explained that the high debt placed upon former colonies from colonizers, such as the International Monetary Funds’ (IMF) infamous Structural Adjustment Programs (SAPs), has created barriers to the development of its infrastructures and economies. Inadequate foreign aid has given these colonies little room to recover, as well as minimizing its ability to fund TB services. Furthermore, crowded and unsanitary conditions in these impoverished communities present barriers to TB prevention.
How COVID-19 has Impacted TB Control Efforts
A study by several infectious disease researchers at the beginning of the pandemic predicted that the effects of COVID-19 on TB programs would result in an excess of 1.65 million TB cases over the next five years. The real numbers, however, may be worse as the world has far surpassed the three-month lockdown prediction of the report. Additionally, there is less availability for TB services as health facilities have moved many people working in the public health or infectious disease fields to COVID-19 research and treatment.
Dr. Haas and her colleagues who care for TB patients have experienced these changes themselves, with many being repurposed to caring for COVID-19 patients. This gap in care will soon be seen worldwide, even after the pandemic has ended. This gap in healthcare will be especially evident in countries like India where diagnoses for TB have fallen by 78% since before the pandemic.
How the Global Health Community Should Respond
Dr. Haas believes it is essential that the U.S. and the global health community reckon with the legacy of colonialism, racism and discrimination in public health. She sees that the community often discounts the impact of colonization on the financial stability and healthcare systems of more impoverished countries. She cited a talk by Harvard professor Dr. Salmaan Keshavjee on how global health organizations have often employed the concept of “only getting what you pay for” to the healthcare systems of low-income countries without trying to solve the resources gap.
Dr. Haas also discussed how government funding toward social protections, like basic income and universal healthcare, could play a significant role in TB eradication. These amenities could potentially relieve financial burdens, reduce poverty and provide people with more access to medical care.
The Global Coalition of TB Activists
In September 2020, a group of non-governmental organizations (NGOs) focused on TB eradication released a report detailing the effects of COVID-19 on TB programs worldwide. The NGOs found global decreases in the number of people seeking diagnostics and care for TB and the ability of healthcare systems to provide such care.
One of the organizations involved in releasing the findings was the Global Coalition of TB Activists, a group focused on community activism to combat TB. In the wake of COVID-19, this organization joined with other groups to form a call to action, asking the international community, including governments and U.N. partners, to maintain funding toward TB programs, to support community organizations and to advocate for human rights in a time when marginalized groups are disproportionately affected by the pandemic. These groups have collected the signatures of nearly 50 other organizations.
In response to the disruption of TB services detailed by these organizations, the WHO has also resolved to maintain efforts toward TB eradication. In the months since the emergence of COVID-19, WHO has monitored and contacted its various TB services for disruptions in treatment, released recommendations for TB programs and organized meetings regarding both TB and COVID-19 vaccine development. Additionally, the international organization used data on the impacts of COVID-19 on TB mortality to determine funding requirements for TB services.
COVID-19 has set back a lot of the progress made in global TB eradication. A lack of capacity and resources in healthcare systems has made it difficult for healthcare providers to treat and track TB, creating considerable concern over the undetected rise in TB infections. The continued efforts of advocacy organizations like the Global Coalition of TB Activists are essential to the global response to TB amid the COVID-19 pandemic. As discussed by Dr. Haas, the most important factor in solving or slowing this crisis is the global recognition of the impacts of colonialism and lack of resources on the healthcare systems of low-and-middle-income countries.
– Ann Marie Vanderveen
Photo: Wikimedia Commons