How Covid-19 Could end Tuberculosis

June 1, 2020

Covid-19 has made it painfully evident that the health systems of the world—in both high- and low-income countries—lack the capacity and infrastructure to handle an emerging pandemic of such a highly contagious disease. Even lauded health systems, such as those in Europe, have proved ill-equipped to handle the onslaught. People all around the world are social distancing and self-isolating at home.

However, this is not the first respiratory pandemic to sweep the world. Long before Covid-19, or other infectious disease outbreaks such as SARS and MERS, another pulmonary pathogen began plaguing the world, going back to the time of the pharaohs in ancient Egypt: tuberculosis.

Many think of TB as a thing of the past, but it is a very real, very deadly presence in much of the world. In fact, TB is the world’s deadliest infectious disease, killing 1.5 million people each year—more than HIV and malaria combined. Further, of the millions of TB cases every year, about 500,000 will develop drug-resistant tuberculosis, which does not respond to the most powerful TB medicines.

The similarities between pulmonary TB and Covid-19 are striking. They are both respiratory in nature and contagious, spreading easily through a population if unchecked. Nearly one-quarter of the world’s population—1.7 billion people—has latent TB infection, meaning they carry the bacteria but are not symptomatic or contagious. Then there are the active TB cases. Each year an estimated 10 million people fall ill from TB, but only seven million are diagnosed. This means three million people are unaware they have active TB—and each can unknowingly infect up to 15 more people each year.

Like Covid-19, TB has proved extremely difficult to contain. In the countries where the disease is most prevalent—like India, South Africa, Russia, and China—health systems already faced hurdles diagnosing and treating TB, even before the emergence of Covid-19. Lack of awareness and inadequately resourced public health infrastructure limits the ability to identify patients with TB. Long, difficult treatment regimens, especially for patients with drugresistant TB, have proved challenging for many patients to adhere to, jeopardizing both treatment and cure. And Covid-19 has introduced new issues: the respiratory challenges faced by both TB patients and survivors may make them among the most vulnerable to infection.

The struggle to eliminate TB should have been a warning sign for what was to come. But the response to Covid-19 shows us that when infectious diseases are taken seriously as global threats, we can move fast to stop them. Right now, we are racing to tackle Covid-19 with innovation, collaboration and speed—and we can unlock this same trifecta to end TB. Here’s how:

First, innovation. We are now witnessing firsthand what can be achieved when the world mobilizes its best science and technology with unprecedented focus and scale to tackle a common foe. New diagnostic tests have been rapidly developed and deployed, and new vaccines are being investigated. Pharmaceutical and biotechnology companies are evaluating their existing assets, like already approved drugs and compounds in development, to potentially prevent or treat Covid-19. Regulatory authorities are accelerating approvals in unprecedented ways. And existing digital technologies are being leveraged to track those who may have been exposed.

Imagine if this same effort could be brought to bear on TB. We would create novel, point-of-care diagnostics to make it easier to find patients. We would create a vaccine to prevent against latent TB infection—or to prevent latent TB from developing into active TB. We would accelerate the discovery of new drugs to improve on the current, complex, months-long treatment regimens. Doing all that would require the same level of prioritization and funding that is currently being deployed to solve the Covid-19 outbreak—and we can do it.

Next, collaboration. Stopping the spread of contagious, airborne diseases like TB and Covid-19 requires intense collaboration among the private sector, governments, academia, multilateral organizations, and non-governmental organizations. In response to Covid-19, these groups are joining forces to increase production of personal protective equipment, to fund response efforts, to accelerate innovative technologies, and to educate the public.

The same level of collaboration would eliminate TB. We would fund necessary treatment programs, build capacity, raise awareness, and support health workers in a coordinated fashion. With more players coming together and mobilizing their resources, we would achieve the United Nations’ Sustainable Development Goal of ending TB by 2030.

Finally, speed. We need to tackle infectious diseases—whether emerging or entrenched—with the same urgency and breathtaking speed we are seeing in the Covid-19 response.

While we have made recent progress in developing new treatments for TB, we must accelerate the timelines, not wait decades for additional tools to be developed, to ultimately save millions from suffering and dying each year from TB.

The spread and fallout of Covid-19 illustrates the urgency and impact of stepping up the fight against TB. Our collective slowness to effectively address TB has both greatly exposed resource-limited countries to the dangers of the novel coronavirus and demonstrated the weaknesses in our global response to pandemic threats. Now, the world’s most vulnerable people are paying the price.

But the steps being taken to contain Covid-19 can serve as the foundation for a final push to eliminate TB. And we need not choose between ending one disease or the other. We can—and we should—do both.

Cat Oyler is a member of the Aspen Institute’s First Movers Fellowship and vice president of strategic initiatives for Janssen Global Services LLC, part of the Janssen Pharmaceutical Companies of Johnson & Johnson.