Adapting Covid-19 Innovations to Accelerate Progress toward Meeting Global Tuberculosis Goals

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The Issue

Tuberculosis (TB) is one of the world’s principal causes of death due to infectious disease. Before 2020, technical innovations in diagnostics, therapies, service delivery, and vaccine development had hinted at a promising future for TB control. But while the annual incidence of new cases had decreased compared to 2015, progress in meeting targets set in the Sustainable Development Goals (SDGs) by 2030 was off track, and the spread of multidrug-resistant TB (MDR-TB), as well as persistent high rates of TB coinfection with HIV, remained key challenges, particularly in lower- and middle-income countries. Since 2020, the Covid-19 pandemic has worsened the global outlook for TB in multiple ways.

As efforts to close gaps, restore health services, and prepare for future health emergencies unfold, it will be important to increase financial commitments for TB programs worldwide; prioritize TB and drug-resistant TB (DR-TB) within pandemic preparedness initiatives; and ensure that innovations and adaptations from the Covid-19 response, including the greater use of digital technologies for diagnostics and data analysis, inform efforts to address the global challenge of TB.


From 2014 to 2019, TB was the number one cause of death due to infectious disease worldwide. And while TB has dropped to second place thanks to another infectious disease with respiratory symptoms, Covid-19, the gaps in TB notifications and delays in patient access to treatment in 2020 and 2021 suggest that TB may be poised to regain its leading status once the acute phase of the pandemic passes.1 Recent data show that the annual number of TB deaths globally increased in 2020 for the first time in 10 years.2

Prior to the 2010s, technical breakthroughs in infection prevention, diagnostics, and therapeutic approaches, along with advances in vaccine development, had offered hope of meeting ambitious goals to reduce the incidence of TB by 80 percent and TB-related deaths by 90 percent by 2030. High-level political events since 2010 have drawn international attention to the importance of reducing the global transmission of TB.3 But while the number of new TB cases each year had declined slightly since 2015, progress in meeting the targets set in the SDGs, as well as the World Health Organization’s (WHO) End TB Strategy, was off track.4 In 2019, around 10 million people were infected with TB, and an estimated 1.4 million deaths worldwide resulted from TB.5

Since 2020, the Covid-19 pandemic has impeded efforts to prevent, test for, and treat TB and DR-TB, including MDR-TB and extensively drug-resistant TB (XDR-TB), undermining the effort to reach internationally agreed targets and creating a setback of 12 years of progress in TB diagnoses and treatment.More than 1.5 million people are believed to have died from TB during the first year of the pandemic.7

Pandemic-era lockdowns and the rapid shift of resources from routine TB services to Covid-19 response have undermined efforts to accelerate testing for and treatment of TB around the world—within high- and low-income countries alike.8 Supply chain disruptions have made access to diagnostic services and medicine a challenge for many TB patients.9 During the pandemic, some have lost access to routine monitoring and counseling activities that help them adhere to treatment regimens, creating conditions favorable for the development and transmission of multidrug-resistant strains of the bacterium, as well as treatment failure.10 The TB Preventive Treatment (TPT) enrollment of people vulnerable to TB infection (or activation of a latent TB infection) dropped between 30 and 70 percent in 2020, while the provision of the BCG vaccine to newborns decreased an estimated 60 percent, in part because of the diversion of BCG vaccines for study and use in adult Covid-19 patients.11 And Covid-19 disruptions have changed the nature of laboratory collaborations and undermined volunteer recruitment for clinical research.12

Surveys undertaken in 13 countries with the highest TB burdens suggest that in 2020, there were 29 percent fewer people worldwide tested for TB compared to 2019 and 45 percent fewer people tested for MDR-TB. These gaps in service access were greatest during the period immediately following the WHO’s March 2020 declaration that the coronavirus outbreak was a global pandemic.13 While reports suggested services were restored in many places by the end of 2020, new data shows that there were at least 1.2 million fewer people diagnosed with TB between January and August 2021, deepening concerns that even the temporary, observed disruptions in TB diagnosis signal an increase in the number of cases that go undetected.14 Over a 12 month period, one person with active, untreated TB can transmit the infection to another 10 to 15 people.15

The decreases in TB diagnoses and notifications in the populous BRICS countries (Brazil, Russia, India, China, and South Africa), where half of all TB patients worldwide live, are particularly alarming.16 For example, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) reported that India had 20 percent fewer notifications in 2020.17 And in northeastern Brazil, a comparison of TB notifications in 2019 and 2020 showed a significant reduction in TB diagnoses following the Covid-19 outbreak.18 The situation is similarly grave in low-income countries.19 Recent data from Malawi, where infection with HIV is linked to an increased risk of active TB infection, shows a drop of nearly 24 percent in TB notifications between April and December 2020.20

Despite the challenges that Covid-19 poses to progress in meeting global TB goals, it is important to recognize the ways in which existing approaches for TB prevention, testing, and treatment, such as the use of personal protective equipment (PPE), high-flow ventilation, and contact tracing, have contributed to the health sector’s readiness for, and response to, the pandemic.21 At the same time, there are several program innovations or adaptations from within the Covid-19 response, including the greater use of digital analytics; new approaches to vaccine research, financing, and manufacturing; and decentralized, community-based delivery of services and medications, that are worth retaining and building upon to improve access to TB services now and in the longer term.

Looking ahead, the TB community—including national governments, bilateral donors, public-private partnerships, and multilateral agencies—can draw on lessons learned during the Covid-19 crisis to urge increased financial commitments for global TB programs; scale-up efforts to collect and analyze data regarding TB and DR-TB diagnoses, treatments, and treatment failures; prioritize TB and DR-TB within pandemic preparedness activities; and ensure that research, financing, and service-delivery adaptations from within the Covid-19 response inform future efforts to address the global challenge of TB.

TB Infection & Treatment

  • TB is a bacterial infectious disease caused by Mycobacterium tuberculosis.

  • Infection with TB does not necessarily mean someone will become ill. TB-related conditions can be described as “latent” or “active.” Many people living with latent TB will never develop active TB disease; however, those with compromised immune systems have a greater potential of progressing from TB infection to TB disease.

  • TB is transmitted from one individual to another via respiratory droplets released when a person with active TB coughs. When a person inhales TB bacteria, they can become infected with TB if their immune system cannot fight off, or clear, the bacteria. TPT is used to treat latent TB infection and prevent progression to TB disease. Beyond infecting the lungs, TB bacteria can also infect other parts of the body, such as the kidney, spine, and brain.

  • TB transmission can be prevented with the use of PPE such as surgical masks and good ventilation in healthcare facilities, workplaces, and homes. The BCG vaccine is recommended for children living in high TB burden settings and for health workers serving patients with drug-resistant forms of TB.

  • TB is treatable and curable with a standard course of four antibiotic drugs taken over a six-month period.

  • DR-TB poses a significant risk to global health security. Rifampicin-resistant TB (RR-TB) is not susceptible to rifampicin, a first-line drug for treating TB; MDR-TB does not respond to at least two standard first-line drugs, including rifampicin as well as isoniazid; while XDR-TB does not respond to first- or even some second-line drugs.

  • In 2019, an estimated 10 million people became sick with TB, and 1.4 million died. Worldwide, TB is one of the top causes of death from a single infectious disease. Eight countries make up more than 66 percent of the global TB burden: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa.

  • The United States government supports TB activities in more than 50 countries, emphasizing TB prevention, detection, and treatment. The United States also supports TB research and development activities. U.S. funding for global TB efforts was $332 million in FY 2021. The United States is the largest donor to the Global Fund, which provides more than 75 percent of all external financing for TB programs.

Source: Please reference the endnote section for complete citations.

The Pre-pandemic TB Political Landscape

Following the introduction and widespread use of antibiotics in the mid-twentieth century, improvements in testing, contact tracing, and treatment had led to a decline in TB cases and deaths by the mid-1980s, at least in high-income countries. However, the HIV epidemic, along with political instability, rapid urbanization, and increasing rates of injection drug use in some parts of the world, drove a global resurgence of TB in the 1990s and early 2000s.22 This turnaround led the WHO to declare TB a global health emergency in 1993, prompting a renewed global focus on testing, treatment, and prevention activities that was enshrined in the Millennium Development Goals (MDGs) and the emphasis on reversing the increase in cases and halving the mortality of TB between 1990 and 2015.23

As the MDG period approached its conclusion in 2015, the annual rate of new cases of TB had slowly fallen by an average of 1.5 percent per year since 2000, with mortality declining globally by 47 percent over the same period.24 Importantly, the number of people successfully completing treatment and being cured was above the MDG target of 85 percent.25 However, there was increasing concern over a rise in drug-resistant strains of TB in multiple world regions and fear that “the spread of resistant strains coupled with fragile health systems and a lack of new drugs, diagnostics, and vaccines to fight the disease are threatening to overturn decades of progress and return us to a pre-antibiotic era.”26 While the overall proportion of TB cases identified as drug resistant during this period was low, at just 5–7 percent worldwide, in some countries such as Belarus and Uzbekistan, more than one-third of detected cases were resistant to multiple drugs.27

To accelerate efforts to reduce the incidence of TB and its associated deaths, as well as to encourage greater commitments to drug discovery and new service-delivery platforms, the WHO launched the End TB Strategy.28 Adopted in 2014 by the World Health Assembly, it envisioned a world “free of TB, with zero deaths, disease and suffering due to the disease” by 2035.29 Shortly after the MDG period came to a close, the Stop TB Partnership, which operates the Global Drug Facility to support drug procurement for the lowest-income countries, among other activities, issued the Global Plan to End TB 2016–2020.30

Two subsequent developments raised the visibility of global TB challenges and galvanized political commitments to address them. In September 2015, the international community adopted the 2030 Agenda for Sustainable Development. Target 3.3 of the associated SDGs focuses on a 90 percent reduction in TB deaths and an 80 percent reduction in TB incidence, that is, the number of new or reactivated TB cases per year per 100,000 people, compared to 2015.31 A related effort refined the classification of countries’ experience of TB to draw national government and donor attention to the overlapping sets of TB challenges in each setting. There are three categories: TB High Burden, TB/HIV High Burden, and MDR-TB High Burden. Each category includes the 20 countries with the highest number of cases, along with another 10 countries that have exceptionally high TB incidence rates.32 Just 20 countries, many of which are classified as low or middle income, account for more than 80 percent of all TB cases in the world.33

The health security risks posed by DR-TB, which accounts for more than 30 percent of all deaths globally from antimicrobial resistance, increasingly influenced international discussions from 2015 to 2018.34 In 2016, the UN General Assembly high-level meeting on antimicrobial resistance acknowledged the importance of incentivizing the development of new therapies and approaches, including for DR-TB.35 At the 2017 Group of Twenty (G20) meeting hosted by Germany, the Hamburg Declaration highlighted TB as a research and development priority.36 The same year, health ministers gathered in Russia to commit to greater multisectoral action, accountability, and financing in the Moscow Declaration to End TB.37 And at the UN High-Level Meeting on the Fight Against Tuberculosis in 2018—a year in which there were an estimated 500,000 new cases of MDR-TB, with just 187,000 cases detected and only 156,000 of those patients enrolled in treatment—global leaders gathered in New York to chart a roadmap for realizing the ambitious SDG targets and End TB Strategy aspirations.38 The meeting’s political declaration recognized that TB is the leading killer of people living with HIV and that MDR-TB is a major concern within the “global challenge of antimicrobial resistance.”39

But while political commitments regarding TB in general, and MDR-TB in particular, had gained momentum toward the end of the 2010s, financing to meet the established targets was much more limited.40 Importantly, the 2018 meeting’s political declaration committed to “promoting access to affordable medicines, including generics, for scaling up access to affordable tuberculosis treatment,” and leaders promised “to mobilize sufficient and sustainable financing, with the aim of increasing overall global investments” to at least $13 billion per year by 2022.41

Historically, national governments have financed the majority of TB services with their own domestic resources. In 2018, just 16 percent of funds for all TB programming globally came from development assistance accounts, and 73 percent of those external funds came from just one source, the Global Fund.42 The resources the fund allocates to MDR-TB activities in lower- and middle-income countries have tripled since 2015, but these grants still represent a small proportion of overall TB spending.43 Bilateral donors provide an additional source of external financing for the most affected countries.

Through its support for the Global Fund—to which it has contributed more than $17 billion to date—and its bilateral assistance activities in over 50 countries, the U.S. government is a key donor supporting global TB programs.44 U.S. bilateral support for global TB programs has steadily increased since 2015, rising from $240 million per year in 2016 to $332 million in 2021.45 The U.S. Agency for International Development (USAID) also contributes to the global dimensions of the National Action Plan for Combating Multidrug-Resistant Tuberculosis by supporting bilateral activities dedicated to strengthening other countries’ capacities to address MDR-TB.”46 Within the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC) supports countries’ efforts to prevent, diagnose, and treat TB, including by assisting national laboratory networks in using new diagnostic tools to detect cases of DR-TB.47 In 2019, the CDC released an updated antibiotic resistance report that placed a high priority on MDR-TB domestically and globally.48 Bilateral activities financed under the President’s Emergency Plan for AIDS Relief (PEPFAR) also provide resources for global TB programs, primarily through support for people living with HIV who are vulnerable to HIV/TB coinfection. At the 2018 UN High-Level Meeting on the Fight Against Tuberculosis, the U.S. Office of the Global AIDS Coordinator committed to providing “TPT to all 13.6 million ART [antiretroviral therapy] patients supported by PEPFAR in 2021.”49

Beyond the United States, several other countries support global TB programs. The governments of Australia, Canada, France, Germany, Ireland, Italy, Japan, the Netherlands, South Korea, and the United Kingdom, among others, have made commitments to the Global Fund and the Stop TB Partnership and have supported TB-related research and bilateral programs.50 Philanthropic organizations such as the Bill & Melinda Gates Foundation fund TB-related drug discovery and regulatory approval activities, while the Vatican-led Rome Action Plan brings together a network of public, private, and nongovernmental partners to support research and programming related to HIV/TB coinfection in children.51

Adapting Covid-19 Innovations to Reignite Progress on TB

At the UN General Assembly meeting in September 2020, Secretary-General António Guterres offered a sobering assessment of how the Covid-19 pandemic had affected progress in meeting the goals set in the political declaration of the 2018 High-Level Meeting on the Fight Against Tuberculosis.52 Guterres’s report described the impact of the pandemic on TB diagnosis and treatment in stark terms, warning that the “annual number of tuberculosis deaths could revert to levels seen in 2015 or even in 2012,” representing a loss of nearly a decade of work.53

The secretary-general’s report underscored that “more ambitious investments and actions are required to put the world on track to reach targets, especially in the context of the coronavirus (COVID-19) pandemic.”54

Yet while there is no doubt that the pandemic has rolled back recent achievements on TB, several innovations from within the global Covid-19 response have the potential to stimulate the “more ambitious investments and actions” envisioned by Guterres by closing existing gaps in diagnosis and access to services and treatment and by advancing research on vaccine development, manufacturing, and distribution. These new approaches include improved contact tracing, as well as digital diagnostics and monitoring; real-time data analysis and dissemination; innovative collaborations for vaccine research and development; and the decentralized, community-based delivery of treatments and monitoring for treatment adherence.

  • The widespread use of digital technologies in gathering and disseminating information for Covid-19 has revolutionized some elements of the approach to respiratory diseases with an overlapping set of symptoms. For example, contact tracing has long been used within the TB field to identify networks of people who may have been exposed to someone infected with TB. But whereas the TB community has traditionally depended on phone calls and direct outreach to find people who may have been exposed, during the pandemic, contact tracing methods have been significantly refined, with rapid scale-up of relational databases and geospatial mapping to pinpoint potential contacts of people who have tested positive for coronavirus.55 Several studies have also shown that the adoption of digital apps to trace contacts and notify people that they may have been exposed to Covid-19 can prompt behaviors that result in significant reductions in infections.56 Applying state-of-the-art digital Covid-19-era contact-tracing innovations to TB efforts could make it easier to identify and test more people who may have been exposed to TB, including DR-TB, than is currently the case.

New approaches to diagnosing respiratory disease have accelerated under Covid-19 and could be adapted, scaled up, and integrated to test and treat people infected with TB more effectively. Medical imaging, coupled with computer-aided diagnosis, has been used in diverse settings to rapidly assess Covid-19 patients’ condition and disease progression.57 In March 2021, the WHO updated its TB diagnostic guidance to recommend the use of low-cost computer-aided detection (CAD) software to interpret digital chest images for TB detection as well.58 Prior to the pandemic, low- and middle-income countries had already begun to scale up the use of molecular platforms such as GeneXpert to diagnose cases of TB and MDR-TB. Having limited access to tests specifically for SARS-CoV-2, the virus that causes Covid-19, many countries used their existing GeneXpert technology to test for coronavirus while awaiting the arrival of lower-cost diagnostic materials.59 While this has represented a diversion of TB resources to Covid-19 response in many cases, it also points to new opportunities to integrate the CAD and molecular platform testing approaches. Using CAD to assess patients’ digital chest X-rays, followed by GeneXpert to confirm TB diagnosis, offers the benefit of being able to screen, confirm, and initiate patients on TB treatment as quickly as possible. Using diagnostic platforms like GeneXpert to simultaneously screen for Covid-19 and TB, as well as other diseases such as respiratory syncytial virus (RSV), can also help ensure the correct diagnosis and timely access to treatment for patients presenting with respiratory symptoms, as has been demonstrated in India.60

The rapid collection and dissemination of data under Covid-19 also have implications for TB. Researchers focused on TB have lamented the slow pace at which information has been made available, often several years after it is collected. However, the accelerated collection, analysis, and public dissemination of Covid-19 data through hundreds of trackers that are updated multiple times a day suggest the potential for observing trends in real time and assessing policy and program efficacy for other conditions, such as TB.61 The software platforms that have linked testing sites, laboratories, and other Covid-19 surveillance tools to local and national databases can be expanded or adapted to include information about TB notifications and deaths, as well as treatment successes and failures, to provide updated and more accurate views of conditions at local and national levels.

  • Pandemic-inspired innovations in the service delivery context have also improved the outlook for some TB patients. During the Covid-19 crisis, lockdowns and supply chain disruptions have rendered patients’ access to essential medications unpredictable. Medication monitoring and counseling, which previously required patients to meet with clinical staff on a regular basis, have become more irregular. But the shift to telephone monitoring and telehealth visits has created new opportunities for some patients to engage with health workers without the burden of traveling long distances to clinics at hours that may be inconvenient for them. In some areas, the shift to telehealth services has improved access to care for patients who were unable to make it to appointments or afraid to visit clinics lest they be infected with Covid-19.62 The greater reliance on community networks to support TB patients during the pandemic, whether for diagnostic referrals or to encourage treatment adherence, has also reinforced the importance of integrating local personnel and resources into TB programs.63

The pandemic has, at the same time, accelerated a trend toward decentralized health services, including home delivery of essential medications and multi-month dispensing of TB medications—something the WHO has recommended for treating drug-susceptible cases but which many countries had been slow to adopt. Similarly, lockdowns and social distancing have hastened a shift to the use of WHO-recommended oral drug formulations that can be taken at home—rather than injections, which, prior to the pandemic, required many MDR-TB patients to make daily visits to health clinics.64

  • Finally, during the Covid-19 crisis, private, public, and multilateral institutions have come together in unprecedented ways to rapidly fund and execute research and product development. The examples of Operation Warp Speed (now the Countermeasures Acceleration Group) in the United States, which supported several companies focused on Covid-19 therapeutics and vaccine development, and the Access to Covid-19 Tools Accelerator (ACT-A)—a global effort focusing on developing and equitably disseminating diagnostics, therapeutics, and vaccines—have shown it is possible to speed up access to new products when the financial risks to developers are reduced and manufacturing begins even before regulatory approval. Given that the number of new drugs developed to treat TB over the last 50 years has been limited, identifying the elements of Covid-19 models that are most likely to lower risk and incentivize TB-related drug discovery and manufacturing will be important, particularly considering that treating patients with MDR-TB could cost the global economy $16.7 trillion by 2050 if no new drugs are introduced.65

    The rapid development and distribution of Covid-19 vaccines—made possible through the unprecedented mobilization of resources and support for research collaborations—also offers hope that TB vaccines currently under development can advance more quickly to the final stages of testing and regulatory authorization.66


Covid-19 has posed multiple challenges to meeting global goals related to TB prevention, diagnosis, and response. At the same time, there are many program innovations or adaptations from within the Covid-19 response that are worth retaining and building upon to improve access to TB services and improve global health security now and in the long term.

In this period of heightened discussion related to health security—including on pandemic preparedness, pharmaceutical innovation, data collection and analysis, and service delivery—donors, multilateral organizations, national programs, and advocates can urge increased financial commitments and greater political leadership on TB in four key areas:

  • Increasing financial commitments for global TB programs through bilateral and multilateral channels. According to the 2021 WHO Global Tuberculosis Report, just $5.3 billion was committed in 2020 to TB prevention, diagnosis, treatment, and care, which was less than half of the annual funding target of $13 billion set at the UN high-level meeting.67 To enhance public health emergency preparedness and reinvigorate progress toward meeting the targets set by the SDGs and the End TB Strategy, there is an urgent need to dedicate additional resources to TB research and programming.

The Global Fund replenishment in 2022 offers an opportunity for donors and advocates to argue for devoting greater resources toward TB programs, which typically receive fewer resources (18 percent of the total) than HIV/AIDS or malaria programs.68 As a key donor to the fund, the United States can urge others to increase their support in the next pledging cycle. If the United States hosts the pledging conference, which could be decided in early 2022, it should also use its role to ensure the fund’s resources devoted to health system strengthening and system-level preparedness are fully supported.

The development of the new PEPFAR Vision 2025 offers an opportunity to advocate for a greater focus on TB/HIV coinfection and MDR-TB within the broader suite of PEPFAR-supported programs. With the anticipated appointment of a new U.S. global AIDS coordinator, the time may be right to urge a deepening of PEPFAR’s engagement on TB and DR-TB within its support for resilient health systems and pandemic preparedness.

  • Rapidly scaling up efforts to collect and analyze data regarding TB and MDR-TB diagnoses, treatments, and treatment failures. Country- and district-level data about TB has historically been available several months to several years after it is collected, but the Covid-19 pandemic has shown that it is possible to track and analyze data about respiratory infection rates and vaccine deliveries in real time. To gain an accurate understanding of how Covid-19 has affected TB control and response efforts, updated information is essential. Efforts such as the CDC’s new Data Center for Epidemic Forecasting, which is intended to “expand broad capability for data sharing and integration,” may be well positioned to initiate and lead global collaborations to learn from systems developed for tracking Covid-19 cases and adapt them for improved global TB surveillance.69
  • Prioritizing TB and MDR-TB within pandemic preparedness activities. During the Covid-19 crisis, patients with active or latent TB infections missed testing or treatment due to periods of lockdown and social distancing, the reassignment of clinical staff to outbreak response, or the disruption of medical supply chains. The decreases in the number of TB notifications in 2020 and 2021 suggest a high number of undiagnosed cases, while interruptions in care increase the likelihood of treatment failure and the transmission of DR-TB, leading to costlier and more difficult interventions. Provisions to ensure continuity of TB, DR-TB, and MDR-TB testing, case identification, and care in the context of a public health emergency should be considered essential elements of pandemic planning.

The pandemic has underscored how essential strong health systems are to health security and public health emergency preparedness.70 Ensuring high-quality contact investigation and case finding for TB along with improving laboratories’ capacity to test for TB and detect MDR-TB can support the development of a health workforce and public health infrastructure capable of responding effectively to a potential pandemic. Supporting primary healthcare services for the purpose of pandemic preparedness can also help expand access to TB diagnostics, testing, and treatment.

In the United States, the White House recently announced America’s Pandemic Preparedness Plan, a 7- to 10-year, $65.3 billion initiative focused on transforming “scientific capabilities” and building national capacities to monitor for disease outbreaks and improve health systems’ disease detection and response. The plan’s development phase offers an opportunity to argue for including TB and MDR-TB in the strategy. At the same time, better integrating TB and MDR-TB into the next phase of the Global Health Security Agenda (GHSA)—in particular its action packages on antimicrobial resistance and disease surveillance and laboratory capacities—could strengthen both health systems and pandemic preparedness in GHSA member countries.

  • Ensuring that research, financing, and service delivery adaptations and innovations within the Covid-19 response inform future efforts to address the global challenge of TB. During the Covid-19 crisis, private, public, and multilateral institutions have come together in unprecedented ways to develop and distribute new products, in part by reducing the financial risks to developers and initiating manufacturing prior to regulatory approval. Identifying the elements of the Covid-19 models that are most likely to lower risk and incentivize TB-related drug discovery should be considered.

Pandemic-influenced adaptations within prevention and service delivery approaches—including improved contact tracing using digital technologies; the increased use of CAD and other artificial intelligence diagnostics; and the shift to decentralized, community-based delivery of treatments and monitoring for treatment adherence—all represent opportunities for enhancing the delivery of TB services by building on existing platforms and approaches.

The rapid development and distribution of Covid-19 vaccines, which were made possible through the unprecedented mobilization of resources and support for research collaborations, also offers hope that TB vaccines currently under development can advance more quickly to the final stages of testing and regulatory authorization.

Although pandemic-era lockdowns and the rapid shift of resources from routine services to outbreak response since March 2020 have negatively affected progress in preventing, diagnosing, and treating TB, several policy and program innovations from within the Covid-19 response may help improve the financing, research, and delivery of TB services now and in the longer term. The considerable mobilization of resources, collection and analysis of data, and acceleration of public-private product-development partnerships in response to Covid-19 create a window of opportunity to advocate for increased financing for TB research and services. With political will and strong financial commitments—and by integrating TB services into pandemic planning—it may be possible not only to regain ground lost during the pandemic but also to reignite progress in meeting global TB goals over the next decade.

Katherine E. Bliss is senior fellow and director of immunizations and health systems resilience with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C.

The author thanks Michael Rendelman for his research assistance and project coordination; Julia Foley, Aidan Winchester, Uma Govindswamy, and Maclane Speer for their research support; and the CSIS iLab for their work on the graphics and production guidance.

This brief is made possible through the generous support of Johnson & Johnson.

CSIS Briefs are produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).

© 2021 by the Center for Strategic and International Studies. All rights reserved.

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Katherine E. Bliss
Senior Fellow and Director, Immunizations and Health Systems Resilience, Global Health Policy Center