key: cord-1010764-wt0z9k8e authors: Ntoumi, Francine; Nachega, Jean B; Aklillu, Eleni; Chakaya, Jeremiah; Felker, Irina; Amanullah, Farhana; Yeboah-Manu, Dorothy; Castro, Kenneth G; Zumla, Alimuddin title: World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis date: 2022-03-03 journal: Lancet Infect Dis DOI: 10.1016/s1473-3099(22)00142-6 sha: 6a4ce606f4f64cb4b2b6391ea4d92e3ce6858a49 doc_id: 1010764 cord_uid: wt0z9k8e nan For the past 2 years the world's attention has rightly been focused on COVID-19, the most lethal pandemic seen for over a century that has amplified the enormous global toll of respiratory tract infections. COVID-19 remains the top cause of death from an infectious disease worldwide, shifting tuberculosis to second place. 1 In areas highly endemic with tuberculosis, scarce resources have been moved to the COVID-19 response, which has undermined tuberculosis testing and treatment programmes. The effects of COVID-19 on global tuberculosis control efforts have been catastrophic, 1-3 setting back by several years any progress being made in achieving the WHO End TB Strategy targets by 2030. 4 For the first time since 2015, the annual numbers of tuberculosis deaths have started increasing and more than 1•5 million people died of tuberculosis in 2020. 1 Furthermore, COVID-19 disruptions to health services have impeded diagnosing and treating everyone with active tuberculosis, drugresistant tuberculosis, multidrug-resistant or extensively drug-resistant tuberculosis, latent tuberculosis, and tuberculosis and HIV co-infection, as well as access to tuberculosis medicines, counselling and follow-up, and lowered treatment adherence. 1, [3] [4] [5] [6] [7] This impedance in turn promotes the development of multidrug-resistant strains of tuberculosis and increases treatment failure rates, suffering, and death. Thus, in the foreseeable future, tuberculosis will continue to pose multiple challenges and negatively impact on already fragile health systems in countries with a high burden of tuberculosis. The theme for this year's World Tuberculosis Day is "Invest to End TB. Save Lives'". Although this theme is appropriate to refocus attention from COVID-19 to tuberculosis, it is a difficult task to achieve. The call for donors to invest more to end tuberculosis is again sadly familiar, yet essential because strategies for holding governments accountable and that advocate for increased investments have been in place ever since WHO declared tuberculosis a global emergency in 1993. 8 It is unlikely that in light of the poor global economic situation, major financial commitments to global tuberculosis control programmes will be forthcoming. However, while the tuberculosis community awaits financial commitments, despair can be turned to hope through more creative and innovative ways of health services delivery. We already have all the tools required to achieve global tuberculosis control targets, [8] [9] [10] and much more can be achieved via new ways of working, innovative strategies, and using existing resources maximally. Over the past 2 years, several promising new developments in approaches to screening, diagnosis, and management for both tuberculosis and COVID-19, if skilfully used, aligned, and synergised, could overcome the negative effects of COVID-19 disruptions in health services for airborne infectious diseases. Several lessons learnt from COVID-19 responses, including innovative new ways of health services working, 3,5-7 also provide a fresh approach to management of respiratory infectious diseases with overlapping clinical symptoms and signs. Several practical steps, using recently updated diagnostics, treatments, patient follow-up, and community care guidelines for both COVID-19 and tuberculosis, 6-10 if immediately taken forward, could have a synergistic, enhancing, and multiplier effect. Thus, COVID-19 programme innovations and adaptations from within the COVID-19 response should be built upon, to enhance access to integrated, patient-centred tuberculosis services (figure). 3, [5] [6] [7] The ongoing COVID-19 mass testing and vaccination rollout in wealthy nations are the result of unprecedented financial investments, rapid research and development, collaborative science, and innovation in delivery systems. Diseases that affect wealthier nations receive immediate attention and the required funding is made available quickly. However, the history of tuberculosis, and now COVID-19, is one of scientific and medical advances, accompanied by political failure to invest appropriately in rolling them out to all in need. The issues of inequities in COVID-19 vaccine distribution to Africa and unfulfilled pledges by wealthier nations, highlights that more visionary leadership, coupled with serious investments, are required from national governments to make countries with a high burden of tuberculosis self-reliant. Continued disinvestments in Africa into both tuberculosis and COVID-19 resulting from lack of political will is unacceptable. Countries that are highly endemic for tuberculosis have all the experience and knowledge on social, economic, and operational determinants that drive the tuberculosis epidemic. There is an urgent need for countries that are highly endemic with tuberculosis to move away from donor dependency and invest in resilient and sustainable health systems. This would provide reassurance to all tuberculosis stakeholders • Ensuring that research, financing, and service delivery adaptations and innovations within the COVID-19 response inform future efforts to address the global challenges of tuberculosis • Generate political will and financial commitments by integrating tuberculosis needs into pandemic investments to regain momentum lost due to the COVID-19 pandemic and to reignite forward progress in achieving global tuberculosis control goals over the next decade. • Common diagnostic platforms for COVID-19, tuberculosis, and other airborne pathogens using similar hardware (eg, NAAT, GeneXpert, and GenoType MTBDRplus) and using easy to obtain clinical samples to simultaneously detect all pathogens, and antimicrobial resistance • Medical imaging (digital chest images with low-cost computer-aided detection) • WHO. Global tuberculosis report 2021 Impact of the COVID-19 pandemic on the detection of TB in Shanghai, China Covid-19's devastating effect on tuberculosis care -a path to recovery The End TB strategy. Global strategy and targets for tuberculosis prevention, care and control after Parallels and mutual lessons in tuberculosis and covid-19 transmission, prevention, and control Lessons learned during the COVID-19 pandemic to strengthen tb infection control: a rapid review Learning from COVID-19 to reimagine tuberculosis diagnosis Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: a call to action United States Agency for International Development and Stop TB Partnership. Implementation of simultaneous diagnostic testing for COVID-19 and TB in high TB burden countries