Are we on the wrong side of the #endTB track?

Shobha Shukla (CNS)
"It is time to stop decades of failure. We have a lot to do to #EndTB by 2030," said Professor (Dr) Guy Marks, President of the International Union Against TB and Lung Disease (The Union), at the opening of the largest TB and lung health conference this year in Bali, Indonesia (Union World Lung Health Conference 2024).
Marks is bang on spot. Historically, we never ever have been on track to end TB in high TB burden countries. At best we have been diagnosing and treating TB and saving lives – and preventing some of TB – but majorly failing to arrest the infection-spread and end TB. If we could prevent TB, then how come 10.8 million people got infected with TB last year as per the new WHO Global TB Report 2024? This amounts to TB prevention failure 10.8 million times last year itself.
Of course, over the decades a lot of work has been done to control TB– but we are still not in TB elimination mode. Millions have got lifesaving TB services but millions more have also got newly infected with TB - year after year. Millions of lives have been saved of TB but over a million die of TB - year after year. We need to face these inconvenient truths that reflect decades of failure - and truly and fully transition from TB control to #endTB response.
Primarily, with an array of evidence-based tools to prevent TB, no one should get infected with TB in the first place - or die of it. Even one TB death is a death too many.
TB treatment is also prevention, because soon after a person with TB disease gets on an effective treatment, infection stops spreading. Nutrition, tobacco control, alcohol control, HIV and diabetes prevention and management, optimal infection control, are important ways to reduce the risk of TB.
If we can find all TB early enough (when it is asymptomatic) and accurately, and link each of the persons diagnosed to effective TB treatment, and support them fully through their treatment and care, we can help shift gears from TB control mode to TB elimination mode.
"TB despite being curable, killed over a million people each year and affected millions more," said  Dr Dirgh Singh Bam, who was delivering his opening keynote address at a session of the global meet. Dr Bam is a noted chest physician, and a former Health Secretary of Government of Nepal; former Director of National TB Programme, Ministry of Health and Population, Nepal; former Director of SAARC TB Centre; and former member of Board of Directors, The Union.
"TB has deeply rooted in several communities around the world as a health crisis, social and economical burden. All stakeholders including TB survivors have to collaborate effectively to find all people with TB - early and accurately - and treat all of them. Community leadership is a force for change when it comes to ensuring equitable access to full cascade of TB, health and social services for everyone-especially those likely to be left behind," said Dr Bam. He called for stronger political commitment at all levels - including sub-national level so that well-coordinated local actions can deliver on the promises enshrined in global goals.
Screen everyone regardless of TB symptoms in high burden settings
While speaking in a WCLH 2024 session on finding, treating and preventing all TB, Dr Kuldeep Singh Sachdeva, reiterated that to eliminate TB we must try to screen the entire population for TB, offer upfront WHO recommended molecular testing to all those with presumptive TB, and put them on treatment without delay. Dr Sachdeva served an illustrious tenure earlier as head of Indian government's TB and HIV programmes, and also served as Southeast Asian Director of The Union. Currently, he leads Molbio Diagnostics as President and Chief Medical Officer.
“We must also look for TB in the not-so-vulnerable populations. You will find 50% of TB in non-vulnerable and non-symptomatic populations. It has been demonstrated in various surveys that 50-60% of individuals who test positive for TB do not have any symptoms and look healthy - they will have symptoms 6 months later when the disease has advanced [and has spread to many more]. Aim of eliminating TB is to find them as early as possible. You can find 50% of the estimated TB in healthy population, if you reach them through the existing tools of TB screening," he said.
Thanks to science, today we have the tools to find all TB, treat all TB and prevent all TB, (and stop the spread of infection) even for those living in disadvantaged and/or difficult to reach areas. We have WHO recommended ultraportable hand- held and battery-operated x-ray machines to screen people for TB; we have WHO approved point of care, battery-operated, molecular diagnostic tools like Truenat;