6.5 TB and health emergencies

Health emergencies, such as the COVID-19 pandemic, are associated with a disruption in health service delivery, either directly due to the focused attention given to the emergency or indirectly due to measures implemented to control the emergency.

The COVID-19 pandemic has reversed years of progress in providing essential TB services and reducing the disease burden of TB. There has been a large global drop in the number of people newly diagnosed with TB and reported. The number fell from 7.1 million in 2019 to 5.8 million (out of the approximately 10 million people estimated to have developed TB) in 2020, back to the level of 2012. Reduced access to TB diagnosis and treatment has resulted in an increase in the number of TB-related deaths. Estimates for 2020 are a total of 1.5 million TB-related deaths (up from 1.4 million in 2019), which means the number of deaths has gone back to the level of 2017. These impacts are forecast to be much worse in 2021 and 2022.

Children and young adolescents have been disproportionately affected by the COVID-19 pandemic, with notifications in children aged under 5 years decreasing by 28% and in children aged 5–14 years by 21% between 2019 and 2020, compared with 18% in people aged 15 years and over (1).

The negative impact of health emergencies is likely to be worse for vulnerable groups such as children and adolescents, who are usually dependent on adults to seek health care. Indirect impacts of health emergencies, such as reduced household income, increased poverty, food insecurity, malnutrition, missed health checks, missed vaccinations and missed schooling, may have a bearing on TB.

NTPs should ensure children and adolescents are not left behind as they design and implement innovative approaches to maintain TB service delivery during health emergencies and in the recovery stage (178).

In May 2021, WHO updated its information note on TB considerations in the context of COVID-19 to guide countries on approaches to maintain the continuity of TB services (179). These approaches should be people-centred while leveraging opportunities across both diseases. For example, both COVID-19 and TB have respiratory symptoms, which provides an opportunity for simultaneous testing to minimize chances of missing either disease and providing appropriate management (180). Invasive sample collection procedures such as sputum induction present an increased risk for TB and COVID-19 transmission if recommended infection control measures are not adhered to. Less invasive sample collection methods can be prioritized in such scenarios (see Chapter 4 on diagnostic approaches).

NTPs should ensure supplies of child-friendly formulations are not interrupted and that children and adolescents with TB are provided with adequate refills to enhance treatment completion and minimize frequent trips to health facilities. This may be achieved via multimonth dispensing or community delivery of TB medicines.
Existing mechanisms should be enhanced to ensure sufficient stocks of TPT for the projected increased need for TPT resulting from people with undiagnosed TB and increased associated exposure because of COVID-19-related lockdowns. Efforts should be made to ensure neonatal and infant BCG vaccination continues uninterrupted.

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