LONDON, England — In 2019, tuberculosis (TB) stood as one of the “top 10 causes of death” in low and lower-middle-income countries and is one of the top three life-threatening infectious diseases in 2021, ranking even higher than HIV. Tuberculosis is a bacterial infection primarily impacting the lungs, but it can spread to other organs and cause a multitude of health complications. Dr. Heinke Kunst is a leading specialist in tuberculosis and has published extensive research on the disease. She is also a senior lecturer at Queen Mary University in the U.K. and a consultant in respiratory medicine. In an interview with The Borgen Project, Kunst provides more insight into tuberculosis and poverty.
The Connection between Tuberculosis and Poverty
Kunst highlights the interconnection between tuberculosis and poverty, saying that “TB usually occurs in people who are socially deprived and live in overcrowded places.” She remarks that the incidence rate is also higher among the homeless, malnourished individuals and patients with HIV, along with people who abuse drugs and alcohol, all of which are risk factors that connect to poverty. Those in developing countries are also more susceptible to contracting TB. This is a vulnerability that Kunst attributes to an increased risk of transmission in unsatisfactory housing conditions.
Expanding on this, she notes that the COVID-19 pandemic has had a detrimental impact on tuberculosis care in developing countries. During the pandemic, many countries had to temporarily suspend TB programs. The consequences of this, Kunst says, included “delays in diagnosis, increasing the risk of transmission and TB mortality.” Kunst explains that under-diagnosis issues stem from the reluctance of people to visit TB centers in fear of catching the coronavirus. The World Health Organization (WHO) has also acknowledged these impacts, stating that tuberculosis deaths increased for the first time in more than 10 years as a result of the COVID-19 pandemic.
Diagnosis, Treatment and MDR TB
Kunst says both diagnosis and treatment are significant barriers to eradicating TB, emphasizing further issues, such as geographical isolation in rural areas of Africa, where people have to travel a long way to reach a health center. Furthermore, developing countries often lack the diagnostics to detect MDR (multi-drug resistant) TB.
Studies show that resistance to TB drugs is high in developing countries, with developed countries only accounting for three high-burden MDR TB countries, according to the 2015 Global Tuberculosis Report.
Kunst finds that “China, India and Russia are especially affected by MDR TB,” and that this occurs due to unsupervised treatment, treatment regimens used without adequate diagnostics and non-adherence to treatment. In the U.K., she says “the rates of MDR TB are low.”
The Impact of Civil Conflict
Kunst highlights Ukraine as an example of the effect that civil conflict has on tuberculosis and poverty. Here, she says, people “didn’t have access to diagnostics or TB drugs.” The staff running the TB control programs in Ukraine appealed to high-income countries for tuberculosis support. This request for support stood as a matter of urgency due to the destruction of many Ukrainian hospitals, but TB cases “remained undiagnosed.” The war in Ukraine has significantly disrupted TB progress in the nation, a damaging consequence considering that Ukraine is a country with high rates of MDR TB.
WHO’s Civil Society Task Force on Tuberculosis (CSTF-TB) urges countries and organizations to commit to continuous funding and prioritization of TB eradication. In 2020, global expenditure on TB diagnosis and treatment services decreased “for the first time since 2016, partly due to “reallocation of resources to the COVID-19 response,” the WHO says.
Kunst says “TB is a preventable disease,” eradicable through investment. TB control programs are integral to the improvement of screening accessibility and treatment time but remain notoriously underfunded. Kunst cites the U.K. as an example of the potential improvements that could occur when a country prioritizes tuberculosis and poverty. She says, “Newham had the highest rates of TB nationally, so [it]developed latent TB screening programs,” thereby decreasing TB rates. The international community must match this effort on a global scale.
The Scope of Issues
Kunst asserts that “innocent people from socially deprived populations are dying and infection rates are soaring unnecessarily.” She and her fellow researchers have applied for funding for a national study looking at the long-term complications of active TB. Existing research finds that TB sufferers are more vulnerable to lung disease, bronchitis and pneumonia, but Kunst identifies a broader range of risks.
Kunst says that TB patients often “experience deteriorating mental health, issues with employment and physical health problems due to complications of their TB.” Kunst describes an increased susceptibility in developing countries where there is no infrastructure to deal with post-TB complications. Furthermore, she notes that: “HIV and TB coinfection leads to further issues and strain on the health care systems.”
The Path to Eradication
For Kunst, on a global scale, countries “need better TB diagnostics and research on how to implement shorter treatment regimens and MDR TB drugs should be made available everywhere.” The Bill and Melinda Gates Foundation, founded in 2000 by American billionaires Bill and Melinda Gates, is one example of an organized effort to fund this cause. The couple introduced the TB Drug Accelerator Program to aid the improvement of treatment regimens and work with WHO and governments in India, China, and most recently, South Africa, to improve TB control efforts.
However, Kunst notes that TB success is a governmental responsibility, saying that “TB funding must be sustainable, with a long-term plan investing a set percentage of GDP.”
WHO estimates that the world must set aside $13 billion worth of funding every year in order to reach global TB targets and eradicate TB. Laws, such as the 2021 End Tuberculosis Now Act, encourage developments and increased funding for the diagnosis and treatment of tuberculosis.
With research, commitment, leadership and advocacy, the world can make more progress toward a tuberculosis-free future.
– Lydia Tyler