TB, formerly believed to be firmly under control in most of the world, has made a foreboding comeback in Southeast Asia. For all the best efforts of the international health community to get the disease under control, TB infections are on the rise again, with the potential to undermine the region’s progress against infectious disease. The World Health Organization (WHO) reports that Southeast Asia is home to one in every three cases in the whole of the global TB burden, and recent trends are pointing in the wrong direction.
In India, Indonesia, and the Philippines, TB remains one of the leading causes of death, at an estimated 3.4 million cases in 2023 alone. Cause for concern is the transmission of drug-resistant strains of TB, which have become widespread and harder to treat. Multidrug resistant tuberculosis (MDR-TB) and extensive drug-resistant tuberculosis (XDR-TB) now comprise an increasing share of fatalities in the region. They do not respond to common TB antibiotics and necessitate longer, more complicated, and less effective courses of treatment.
TB has resurged in Southeast Asia due to various causes. One of them is that the COVID-19 pandemic hit TB control hard. Lockdowns, restriction of movements, and shifting of healthcare services to manage the pandemic brought TB services, such as diagnosis, treatment, and tracing of contacts, to a standstill. In 2020 and 2021, the global response to prevent and respond to TB came to an almost complete standstill, and millions of people were denied TB care and diagnostic services.
In addition to the impact of the pandemic, health infrastructure in much of Southeast Asia remains in disrepair and over-burdened. Healthcare networks in countries like India and Indonesia have already-full plates of public health problems, including malnourishment, respiratory disease from air quality, and creeping waves of non-communicable disease. TB, in its adaptable form incubating in environments of poverty, crowded living, and poor diets, has found its fertile ground in those countries.
This problem is intensified by TBstigma. TB patients not only have a fear of discrimination against them,but they also fear isolation, and do not seek doctors. Stigma is worse in rural areas, where health facility access is low and myths surrounding the disease abound.
In the Southeast Asian region, TB has also been complicated by TBtransmission among high-risk groups, i.e., people living with HIV, migrants, and prisoners. These groups are vulnerable to TB because of their compromised immune status or living conditions that facilitate transmission of the disease. In certain countries, TB among prisoner populations has already reached epidemic levels, fueled by prison overpopulation and inadequate healthcare in prisons.
In an effort to prevent TB’s resurgence, scientists call for increased investments in TB diagnosis, prevention, and treatment. Despite achieving success in developing TB vaccines and quick diagnostic tests, they have yet to become accessible everywhere, largely in settings of limited resources. Global institutions such as Stop TB Partnership and WHO continue to issue stronger calls for national measures against TB in terms of better surveillance, public health efforts, and better access to services. The resurgence of TB in Southeast Asia serves as an alarm for the global health community. Even as we grapple with dealing with our current pandemic of COVID-19 and other emerging public health emergencies, we can in no manner ignore other such diseases like tuberculosis which continue to take lives and undo hard-won gains in global health.
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