31.8 million people will have died by 2030 if tuberculosis is not eradicated.

The world pledged five years ago to reduce tuberculosis to a minimum by 2030. Since then, many expert voices have warned that progress has been made, but little: with the data in hand, it is known that deaths and infections do not decrease fast enough, nor is it reaching all the patients estimated to be out there with diagnoses and treatments.

Now, for the first time, a group of American researchers has estimated how much it will cost us not to comply: 31.8 million lives and 17.5 billion dollars due to the mortality and total costs derived from this disease, the most common infection, which already causes an average of 1.4 million deaths each year.

The results of this research were presented on Wednesday at the 51st World Conference of the Union on Lung Health, the largest event in the world on this subject.

The findings presented are based on projections made in 120 countries for 2030, 2045 and 2050 in order to find out what the cost will be in “total cost” if the disease is not ended, that is, the sum of the impact on economic growth plus the added value of people’s lives.

“For legislators, it provides a fairly complete picture of the cost of premature mortality,” said Suchin Silva, a scientist at Harvard University and co-author of the report, in a virtual press conference as is the entire conference. This year it should have been held in Seville, but it has been switched to online because of covid-19.

The research carried out in three hands by the universities of Harvard, California and by Imperial College London, raises various scenarios based on the goal that was set in 2015 with the approval of the End TB strategy, that is: to reduce the number of deaths by 90% in 2030, and to reduce the incidence to 80% compared to 2015 data. “This is now very unlikely,” lamented Silva.

In 2018, tuberculosis claimed 1.4 million lives, including those of people who also had HIV, and each death cost an average of $1.3 million, they estimate.

The worst affected regions were Sub-Saharan Africa and South Asia and, specifically, seven countries: India, South Africa, Nigeria, Indonesia, China, the Russian Federation and Angola, which bore 71% of the total losses (human and economic) .

The worst possible scenario contemplates that we will achieve the goals two decades later than expected, in 2050. This will happen if we continue with the current rate of decline in mortality, of 2% per year.

By then, there will be 31.8 million deaths and the equivalent of $17.5 trillion in economic losses. At the other extreme, the best possible scenario: the one in which the goals are met in 2030 because of the rate of decline in mortality increases.

But it still wouldn’t come for free: by 2050 there will have been a total of eight million deaths between 2020 and 2050, with a total loss of revenue of $4.34 trillion.

Researchers believe, however, that the most likely scenario is that the End TB targets will be met in 2045, in part due to the impact of COVID-19, which has also been taken into account when making the projections.

In this case, a total of 13.7 million deaths may occur and the resulting total revenue losses will be $7.30 trillion.

“The pandemic has taken a heavy toll on services for many diseases, including tuberculosis, with sharp drops in TB notifications reported in several high-burden countries. This could lead to 400,000 additional deaths from tuberculosis this year alone,” recalled Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), during the opening ceremony of the conference last Tuesday.

Researchers, in fact, also warn that the COVID-19 pandemic may undermine efforts to end the disease.

“The neglect of tuberculosis programs in the short term can have devastating economic consequences in the long term,” they indicate in the conclusions of their study.

However, they have also suggested that the huge global investment being made to fight the new pandemic could be an advantage if new coronavirus containment strategies are used to improve the detection and prevention of tuberculosis.

Another of the results presented this Wednesday are those of phase III of a clinical trial on a new drug regimen that reduces treatment time by a third: from six months that usually lasts to four. It is the first successful short-term treatment for the disease in nearly 40 years.

The trial was conducted with 2,516 participants from 13 countries and the main criterion to assess its efficacy was that the patients no longer had Koch’s bacillus (the cause of the infection) 12 months after starting treatment with a high dose of rifapentine ―one of the drugs used against the disease― combined with an antibiotic called moxifloxacin.

“The standard six-month regimen cured 90% of the participants, and the four-month regimen containing rifapentine and moxifloxacin cured 88%,” detailed Susan Dorman, one of the study’s authors, at a press conference. The safety and tolerance of the new treatment were similar to the traditional one.

“Shortening treatment can benefit patients, their families and our health systems. A shorter regimen will allow patients to heal more quickly and can reduce treatment costs, improve quality of life, and help more people successfully complete their treatment,” Dorman pointed out.

Risk in pregnant women

The health of pregnant women has also been put on the table in this virtual macro event. The authors of the South African Medical Research Institute assumed that tuberculosis is associated with an increased risk of death among pregnant women, and more among those who are also seropositive, and wanted to verify antiretrovirals combined with preventive therapy based on Isoniazid or IPT, another of the drugs present in the cocktail that is administered to tuberculosis patients, which can reduce mortality rates.

They analyzed data from 1,215 South African women in the second or third trimester of pregnancy, of whom 68.6% had started IPT during pregnancy. More than 94% of them delivered live children and had a lower risk of miscarriage, compared to a somewhat lower percentage of those who did not follow any therapy.

Finally, the authors conclude that IPT exposure during pregnancy produces higher live birth rates and that it can be used safely in the second and third trimesters of pregnancy.

However, they also note that with recent changes in treatment regimens for tuberculosis and HIV, more research is needed to determine the safety of therapies during each trimester of pregnancy and to evaluate their outcomes.

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