Pandemic resources and better living conditions are key to tackling TB in Southeast Asia

Tuberculosis is currently the world’s second biggest infectious killer, after the coronavirus COVID-19. The pandemic devastated national TB prevention and treatment programs, causing an estimated half a million excess deaths between 2020 and 2022.

The good news is that there has been a post-pandemic recovery in the number of people diagnosed with and treated for TB, helping to reduce the damage done by the pandemic. But the disease remains rife in Asia and the Pacific, with Southeast Asia responsible for 46% of global infections in 2022, the highest of any region, according to the World Health Organization.

Many developing countries in the region still have a high tuberculosis incidence rate. A number of them have well over 300 cases per 100,000 population, based on 2022 data, according to the Asian Development Bank’s Basic Statistics series, which presents data on social, economic, and Sustainable Development Goal indicators for economies in Asia and the Pacific.

The Philippines, along with Indonesia, Mongolia, Papua New Guinea, and Viet Nam, have some of the highest levels of TB in the region, according to the WHO Global Tuberculosis Report 2023, Around 700,000 people out of a population of 115 million have active TB.

Nearly 10 million people in the Philippines reside in impoverished urban area. Poverty and overcrowding, along with poorly-resourced public health services, are major factors in the widespread incidence of TB in the country, according to The Lancet.

Basic Statistics figures for the Philippines in the past five years hovered around 550 per 100,000. It increased to 638 per 100,000 in 2022, representing a post-pandemic increase in detection and diagnosis as national TB programs recovered.

Several initiatives have been launched in the Philippines to end the disease, including increased screening in vulnerable communities. Yet the numbers remain stubbornly high. International collaboration to fight the disease has had some success. 

A partnership between the Philippine Department of Health and the Japan International Cooperation Agency introduced AI-assisted X-ray detection, which is much faster than the usual skin or blood tests.

In tandem with improving detection, the country is seeking to elevate levels of awareness and help remove the social stigma associated with visiting a TB diagnosis and treatment center.

A group of Filipino medical practitioners writing in The Lancet in 2022 argue that interventions to reduce the country’s stagnant TB rates must be directed at populations most affected.

Primarily a disease spawned by urban poverty, they prioritize those in overcrowded areas, those on low incomes without access to education and health care, inmates in overcrowded prisons, and young people living with HIV without access to antiretroviral treatment.

In Indonesia, TB is the fourth highest cause of death overall, and among those aged 15 to 49 years, it is the number one cause of death by a communicable disease.

While the country has made progress over the past decade toward reducing TB incidence and increasing treatment success rates, significant challenges to eliminating the disease remain. A comprehensive national plan to combat TB in Indonesia aims to accelerate elimination efforts by 2030 and to end TB by 2050. The plan includes optimizing early detection and increasing access to quality diagnosis and treatment services.

Many countries are working to eliminate TB by 2030, in line with the WHO’s End Tuberculosis Strategy. But the pandemic has impacted negatively on those national drives to tackle the disease.

As national TB programs recover, one easy and low-cost option to divert more resources to fighting TB is to repurpose pandemic health care infrastructure, testing facilities and education programs to turn them to tackling pre-existing communicable diseases like TB.

Adapting practices such as mask wearing and improved hygiene at home and work that proved to be effective against COVID-19 could play an important role in helping Asia and the Pacific to rid itself of TB permanently.  

Now that the pandemic is over, we must remain focused on improving the health sector to get back on track so that TB diagnosis and treatment can continue to expand. The reality is that it is socioeconomic factors that allow the disease to remain endemic: poverty, overcrowding, poor sanitation, lack of infrastructure and inadequate public health systems.

Along with public health measures, sustainable economic growth is needed to end one of the biggest health problems in Asia and the Pacific.

Source: Asian Development Bank