Recent Tuberculosis outbreaks in the US are a call to action

Even though the COVID-19 public health emergency has ended, recent hospital data suggest cases of COVID-19 are rising modestly. At the same time, tuberculosis (TB) infections and TB disease outbreaks are also rising. And cold and flu season is just around the corner.

The symptoms of these conditions, and others, often overlap, involving coughs and fevers. All of them are highly contagious, and for vulnerable populations - including the very young, the elderly and people with compromised immune systems - all of them can be deadly.

We must act to apply the lessons we learned from the COVID-19 pandemic to the infectious diseases circulating among us.

National governments, international bodies and industry should work together to leverage the processes we built during COVID and strengthen the areas that weakened our response.

Quite simply, preventing the next infectious disease pandemic is the only way to honor the 7 million lives lost to COVID ⁽¹⁾.

The spread from a single individual

In May, the World Health Organization declared an end to the COVID-19 public health emergency it had announced 15 months earlier ⁽²⁾. Yet more than 30 years after an emergency declaration for TB - the world's next-most lethal infectious disease, which is both preventable and curable - progress has been woefully inadequate and there is no end in sight.

In the US, an estimated 13 million people live with inactive or latent TB, and 1 in 10 will convert to active, contagious TB.

In just the last few months we've seen TB outbreaks in Alabama, Virginia, Arizona, New York and Canada. In Washington state, a woman with active TB disease who refused to isolate or be treated was imprisoned.

In Minnesota, the state Department of Health confirmed last week that it's tracking an outbreak of TB, including four active cases in Washington County within the Anywaa community ⁽³⁾.

It is estimated that one person with active TB disease has the potential to infect 10 other people around them. Like COVID, TB could very quickly create a large scale public health emergency - one that can only be contained with robust TB infection testing and contact tracing.

Mobilizing a global community

It is notable that the agenda of September's United Nations General Assembly includes three high-level meetings on health spotlighting three interconnected priorities: TB, pandemic prevention, preparedness and response, and universal health coverage.

COVID's lethal urgencies pushed TB down the global-health priorities list for a time. We must redouble efforts and commit to even more funding, testing, and treatment. COVID showed that the global community can mobilize financial resources, harness innovation and quickly deploy essential health care services.

The pandemic made routine testing a part of daily life for millions of people around the world. We can - and must - now do the same for TB.

COVID also proved the value of wastewater testing as a surveillance tool, especially with technological advances like digital PCR - which can rapidly detect a single positive case among 10,000 people days or even weeks before anyone develops symptoms.

Just recently, Mpox was found in wastewater in Palm Springs, Calif. ⁽⁴⁾, before any cases appeared in the clinic, giving public health authorities a crucial head start for vigilance and prevention.

Investment into a shared database

We need greater investment in wastewater surveillance to track potential threats in real time, and much better coordination among public health partners than exists today.

All testing efforts should operate from a single, shared database and pathogens list, with uniform applications and inspections at "sentinel" surveillance sites - the specially equipped laboratory facilities that collect data to monitor for potential threats.

Widespread surveillance at, for example, refugee processing or "welcome" centers in South and Central America would boost detection capabilities while also providing essential humanitarian support for the millions of people seeking refuge from failing economies, climate change and violence.

We know the next pandemic is a question of "when" rather than "if." Diseases don't respect borders and not all travel can be controlled, especially in the midst of today's unprecedented global refugee crisis.

Our pandemic preparedness, prevention and response planning must become more strategic, more targeted and more holistic.