Though COVID-19 has vastly disrupted the prevention and care programmes for tuberculosis (TB), Germany remains one of the main contributors to the global fight against the disease. On the occasion of World TB Day 2021, Healthy DEvelopments takes a closer look at the challenge and Germany’s contribution to eliminating TB.

‘When corona struck India, everyone panicked. People who were already TB patients started getting scared,’ says Aftab Ansari, a healthcare worker in Mumbai, India. Himself a survivor of an extensively drug-resistant TB, a strain of tuberculosis that is very difficult to treat, he decided to start working in Mumbai’s poorest slums, helping those afflicted with TB.

India accounts for over a quarter of all new TB cases worldwide. Until COVID-19 struck, it had been making steady progress in the fight against the disease. But in the two months following lockdown in 2020, case notifications dropped by more than 50%. This sounded the alarm bells, says Ansari, as people with TB who are not diagnosed can continue to spread the bacteria– resulting in more cases and deaths – especially in densely populated urban areas like Mumbai. Finding these ‘missing’ cases is critical in winning the fight against this ancient disease.

‘It is very dangerous if they get TB and don’t check it,’ says Ansari.

Tuberculosis kills more people than any other infections disease

Transmitted through droplets from coughs, sneezes or just talking, TB is both preventable and curable. Nonetheless it claims the lives of over 4,000 people every day, in 2019, killing 1.4 million people, and infecting an estimated 10 million worldwide (WHO, 2020).

In 2018, the United Nations set itself an ambitious goal: to find and treat 40 million people with active TB between 2018 and 2022, and provide preventive treatment for 30 million people with latent TB – particularly vulnerable people, for example children and people living with HIV. But the covid-19 pandemic may push that goal out of reach and disruptions to TB treatment could lead to an increase in strains that are resistant to treatment –and which also tend to be the deadliest. This is why continued global attention and efforts to combat the disease are essential.

How does Germany contribute to the fight against TB?

Germany helps in the global campaign against the disease through financial and technical cooperation with international partners. One of its most important partners in this endeavour is the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Germany takes a proactive role in the Fund’s Governance. On behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), KfW Entwicklungsbank helps establish reference laboratories, hospitals and assists with vaccine development and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) supports hospital partnerships addressing TB in 11 partner countries in Asia and Africa.

Working with the Global Fund

GFATM is the world’s biggest financier of AIDS, TB, and malaria prevention, treatment, and care programmes – activities closely linked to the sustainable development goal SDG 3, ‘Ensure healthy lives and promote well-being for all at all ages’, and in particular the sub goal 3.3, ‘By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

Today, Germany is the fourth largest government contributor to the GFATM. It is part of the Global Fund Board, and also a member of the Strategy Committee. In these positions and together with other partners it is playing a pivotal role in shaping Global Fund policies, notably on building resilient and sustainable systems for health, on improving the governance of national coordination mechanisms and on ensuring the correct use of funds through risk management.

For 2020-2022, Germany pledged €1 billion – a 17.6% increase from its previous commitment. Its investments have helped the Global Fund partnership save more than 32 million lives and reduce deaths from TB, AIDS and malaria, on average, by 40 percent.

Supporting the development of vaccines

The standard treatment for drug-resistant TB at present includes highly toxic medications which have to be taken for up to two years. The potential negative side effects include the possibility of permanent deafness, while the medications have a limited cure rate of between 25-50 percent (Economist, 2019). To tackle this, BMZ is also contributing EUR 10 million to the Global Health Investment Fund (GHIF), which promotes the development and launch of new drugs and vaccines, including vaccines against TB for adults and children.

On behalf of the German Federal Ministry of Education and Research (BMBF), KfW is accelerating the development and availability of urgently needed new drugs by working together with TB Alliance, a not-for-profit product development partnership dedicated to the discovery and development of new, faster-acting and affordable TB medicines.

Establishing laboratories across central Asia and in East Africa

Through KfW, Germany helped in the establishment of national reference laboratories in Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan and Pakistan – all countries with high rates of drug-resistant TB which previously had inadequate or non-existent laboratory capacities for specialist diagnoses. This measure helps to improve the diagnosis and treatment of various forms of TB in accordance with WHO standards. In the same countries, German assistance also helps to set up TB treatment facilities.

In cooperation with the East African Community, KfW is also helping to set up a network of national reference laboratories. These are complemented by mobile laboratory units which can be sent to regions where outbreaks are suspected, using state-of-the-art technology in compliance with the required safety standards.

A strong partner committed to help ending TB

Since 2016, BMZ has been supporting TB containment in eleven partner countries in Eastern Europe and Sub-Saharan Africa (including Moldova, Namibia, Tanzania, Ethiopia, Côte d’Ivoire, Ghana, Guinea, Cameroon, Kenya, Liberia, Malawi) through the ‘Hospital Partnerships – Partners Strengthen Health’ initiative. Medical, nursing and laboratory staff from German and partner hospitals collaborate at eye level, learning from each other and joining forces in their commitment to help end TB.

Back in Mumbai, Ansari says that having lived through and recovered through a particularly difficult strain of TB helps him win other people’s trust, encouraging them to seek treatment early.

‘I share my personal experience with patients. I also tell them: ‘If I can recover from TB why can’t you?’, ‘ he says. ‘If I can help the lives of even 10 people, I will consider it my good fortune – and I will never give up.’

Inna Lazareva, March 2021