The number of people infected with tuberculosis (TB) has risen globally for the first time in almost 20 years, prompting accusations that the disease has been neglected because it affects the poor. According to the World Health Organization (WHO), 10.6 million people were diagnosed with TB in 2021, a 4.5% increase on the previous year. The number of new cases had dropped by an average of 2% most years since 2000. TB-related deaths rose for the second consecutive year to 1.6 million in 2021, said the WHO yesterday. Many people were unable to get a diagnosis or receive treatment during Covid lockdowns. Dr Lucica Ditiu, the executive director of the Stop TB Partnership, said: “It has become very clear that we now have a very dangerous situation on our hands with an airborne disease that is completely neglected, and which has been allowed to run rampant over the past two years. “Despite this shockingly upward trend of TB mortality and infection rates, funding for fighting TB decreased in 2020 and 2021 from an already pathetically low level. This is infuriating and it makes me wonder why there is such a lack of investment for TB. Is it because governments do not care for their own people? Is it because the life of a person dying from TB is less important or is it because TB affects mainly poor people from poorer countries, and it is more comfortable to simply neglect them?” Mel Spigelman, president of the TB Alliance, said Covid had diverted “scarce resources” from TB programmes and from the development of new tools to tackle the disease, including vaccines. “Medical breakthroughs like effective vaccines, more powerful drug regimens and point of care TB diagnostics are desperately needed, now more than ever,” he said. TB, which mostly attacks the lungs, spreads through airborne droplets. It can remain latent for many years before it causes health problems and can be difficult to diagnose. The ability to control transmission is limited because the current vaccine, known as BCG, is more than 100 years old and has limited efficacy in adults, according to ProfJamie Triccas, a TB researcher at the University of Sydney. Triccas said some potential vaccines have reached late-stage trials, but the funding needed to develop them isn’t there. According to a December 2021 report by the Treatment Action Group and the Stop TB Partnership, the total amount of global funding for tuberculosis research was $915m in 2020 – far below the $2bn goal set by the UN in 2018. Of that total, 13% of it was spent on vaccine research, while billions were invested in Covid vaccines. “It is perhaps the quintessential disease of poverty and therefore does not have the political pressure and financial incentives behind it that do diseases that affect the more affluent parts of global society,” said Spigelman. According to the WHO’s annual Global TB Report, there has been decline in global spending on essential TB services from $6bn in 2019 to $5.4bn in 2021, which is less than half of the global target of $13bn. Tedros Adhanom Ghebreyesus, the WHO’s director general, said: “If the pandemic has taught us anything, it’s that with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threats. Let’s apply those lessons to tuberculosis.” The main source of international funding for TB is through the Global Fund to Fight Aids, Tuberculosis and Malaria, which last month received $14.25bn of the $18bn it wanted to fund its work for the next three years. The UK failed to commit any money.