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Introduction

Despite being preventable and curable since the middle of the twentieth century, tuberculosis (TB) has long persisted as the world’s deadliest infectious disease, with the communities most devastated by TB among the poorest and most vulnerable in the world. Each year, approximately 10 million new people become sick with TB—it is estimated that an additional 3 million people go undiagnosed—and 1.4 million people die of the disease (WHO, 2020). Only about half of people with TB receive successful treatment each year. As the global threat of antimicrobial resistance continues to escalate, so do cases of drug-resistant TB, or TB that is resistant to various antibiotics that constitute standard treatment regimens. In 2020, more than 500,000 people became ill with drug-resistant TB, yet only one in three had access to treatment (WHO, 2021d).

Since TB was declared a global health emergency by the World Health Organization (WHO) in 1993, momentum has been building toward eliminating TB across the world through the development and implementation of more effective strategies to detect and diagnose people with TB, support them throughout treatment, and prevent them from spreading TB within their families and communities. Although these efforts have had a significant effect on the global disease burden, much work remains to close critical gaps in detection, diagnosis, treatment, and prevention of TB in order to avert unnecessary suffering and death caused by the disease.

Unfortunately, COVID-19 and its mitigation efforts have taken a destructive toll on countries with the highest burden of TB disease and have diverted attention and resources from the global TB response, threatening to reverse years of progress toward eliminating the disease. Alarmingly, the

majority of countries across the world have reported decreases in both the numbers of people diagnosed with TB and the number of patients receiving treatment during the COVID-19 pandemic (Stop TB Partnership, 2021). Recent modeling exercises estimate that the initial effect in 2020 of the COVID-19 pandemic will result in an additional 1.4 million TB deaths between 2020 and 2025 (Stop TB Partnership, 2020). WHO (2021b) has also estimated that rates of TB will be higher in 2021 than in recent years, while worldwide TB case notifications will decrease by 21 percent and an additional 500,000 deaths will occur between 2019 and 2020.¹

Ambitious global targets for TB elimination have been established by the United Nations High-Level Meeting (UNHLM) on Tuberculosis (UN, 2018), which set targets for 2022, and WHO’s End TB Strategy, which set targets for 2030 (WHO, 2015). Even prior to the COVID-19 pandemic, the rate of progress in global TB control had stagnated and the pace was insufficient to achieve those goals without urgent collective action by the international TB control community. In the midst of the COVID-19 pandemic, those efforts will need to be redoubled to avoid losing ground in the fight against TB and to foster a renewed global commitment to tackling the disease.

WORKSHOP OBJECTIVES

On July 22, 2021, and September 14–16, 2021, a planning committee under the auspices of the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a two-part virtual workshop titled Innovations for Tackling Tuberculosis in the Time of COVID-19.² The aims of the workshop were (1) to evaluate the current status of TB elimination, (2) to assess the effects of the COVID-19 pandemic on the global fight against TB, and (3) to examine technical and strategic innovations that could be used to meet the UNHLM targets in 2022 and WHO’s End TB Strategy targets by 2030. The virtual workshop featured invited presentations and discussions to consider the following:³

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¹ TB is a notifiable disease in many countries. This means providers are required to report diagnosed TB cases to relevant health authorities, and these data are ultimately shared with WHO. Reporting requirements are not uniform across all countries, and the End TB Strategy has called for enforcing current notification requirements. For more information see Uplekar et al., 2016, and WHO, 2015.

² The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

³ The list of references is found in Appendix A. The full statement of task is in Appendix B, and the workshop agenda is available in Appendix C.

• How can we accelerate the development of affordable point-of-care tests for TB? What barriers or challenges have prevented the development of accessible point-of-care tests for TB in low- and middle-income countries?
• Improvements in the usual care for TB: Can we achieve a 2-week, nontoxic treatment for drug-sensitive and drug-resistant TB?
• How can we rapidly use the TB platform, such as contact investigation, in low- and middle-income countries to address COVID-19 and other airborne infections to prevent future pandemics?
• How can we ensure increased and sustained commitments to reach the UNHLM?

ORGANIZATION OF THE PROCEEDINGS OF THE WORKSHOP

In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on information presented, questions raised, and improvements suggested by individual workshop participants. Chapter 2 summarizes the first part of the workshop, which focused on current tools and challenges related to tackling tuberculosis in the time of COVID-19. Chapter 3 explores the state of TB detection worldwide and the progress underway to improve case finding, diagnostics, and notification. Chapter 4 examines advancements in TB vaccines and therapeutics. Chapter 5 addresses ways to bolster financing, ambition, and preparedness in strategies to eliminate TB in a global context that has been dramatically changed by the COVID-19 pandemic.

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