The Russian invasion of Ukraine could be “devastating” for tuberculosis control in eastern Europe, and will cause a “terrible public health tragedy”, Dr Anthony Fauci has warned.
Ukraine reports roughly 30,000 new TB cases annually and has one of the highest rates of multidrug-resistant TB in the world. According to the World Health Organization estimates, Ukraine has the fourth highest TB incidence rate among the 53 countries of the WHO European Region.
“[The war] could be devastating, quite frankly,” Dr Fauci, the chief medical officer of the United States, told The Telegraph in an exclusive interview.
“As a public health official, as a scientist, and as an infectious disease expert, I’m very worried about the disruption that has already happened and that will continue.”
He criticised the “indiscriminate attacks” on the Ukrainians, adding: “Hospitals being moved to cellars, clinics having to close, are going to have a terrible impact on TB and any other diseases – HIV, infectious disease of children.
“[The war] is going to interrupt the vaccine programmes of kids, this is going to be a really terrible public health tragedy – in addition to a terrible tragedy of life lost in war.”
TB remains the second leading infectious killer globally, second only to Covid-19. In 2020 it led to 1.5 million deaths. The WHO has warned that multidrug-resistant TB is a public health crisis and a health security threat.
While TB deaths had decreased since 2005, since the pandemic they have risen. Dr Fauci said this was down to healthcare disruptions, which saw less people diagnosed and therefore not adequately treated.
The WHO said in 2021 that Covid has “reversed years of global progress in tackling tuberculosis”.
Dr Fauci said it’s vital that the scientific community now applies modern technologies to tackle the “ancient disease.”
“We still do not know as much as we need to [about TB]. We need to revitalise what has been a somewhat neglected approach to an ancient disease,” he said.
“We have not used cutting edge technology [on it]. And we have a lot of people who are not interested in the field of TB because there’s been this somewhat inappropriate mindset: ‘It’s been around for a long time and we do have the BCG vaccine’,” he told The Telegraph.
But, he warned, BCG, which has been used for more than a century, has “great limitations”. The vaccine is 70-80 per cent effective against the most severe forms of TB, such as TB meningitis, but is less effective in preventing the form of TB that affects the lungs.
TB is particularly dangerous in southern Africa, Dr Fauci said, where there is a high prevalence of HIV. TB is the leading cause of death in people living with HIV.
Dr Fauci’s comments come after Dr Mike Ryan, head of the WHO’s emergencies programme, said this week that Ukrainians are also at heightened risk of coronavirus.
“Anytime you disrupt society like this and put literally millions of people on the move, infectious disease will exploit that,” he said. “People are packed together, they’re stressed, they’re not eating, not sleeping properly. They’re highly susceptible [to disease].”
Ukraine is lagging on Covid vaccine uptake – according to Our World in Data, just 35 per cent of the population has had two Covid shots – and plans to launch vaccination drives have been suspended due to the fighting.
On Tuesday, Dr Jarno Habicht, of the WHO, said health systems in neighbouring countries must enhance their infectious disease surveillance to prevent cross-border outbreaks of diseases like Covid, measles, and vaccine-derived polio.
Since the Russian invasion began, hundreds of structures – including transport facilities, homes, nursery schools and hospitals – have been destroyed. This includes a cancer hospital for children which, according to The Kyiv Independent, was hit by Russian artillery fire on Sunday, killing at least one child.
“In the last few days, our hospitals and other public places are what Russian terrorists are targeting,” Dr Andrii Strokan, deputy chief physician at Feofaniya Clinical Hospital in Kyiv, told The Telegraph this week.
“[On Monday] we had a patient with a gunshot wound to the brain. A paramedic from the ambulance brigade was shot in the street during the patient’s transportation,” he said.
Dr Lesia Lysytsia, a paediatric onco-ophthalmologist at Okhmatdyt, Kyiv's largest children's hospital, added that one ultrasound room at the facility has already been destroyed amid gunfire – though she believed this was not a targeted attack.
“The children are really, very scared, the [explosions] are awful,” she told The Telegraph. “We had one room, with the ultrasound [unit] in it, which was attacked – shot from the window. We think it was an accident.”
Dr Fauci said: “I know that there are a lot of groups that are now amassing on the border of Poland to help, people going right into Ukraine, as dangerous as it is, to try to provide some modicum of health care during this very difficult time.
“We, the global community, [must] do whatever we can to mitigate against what is going to be an absolutely profound disruption of healthcare.”
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