Once considered a model for tuberculosis (TB) control in Eastern Europe, Ukraine’s national TB program—praised for its innovation and effectiveness—has been severely disrupted by the ongoing war. Hospitals have been bombed, critical medication stockpiles destroyed, and patients displaced across borders, putting years of progress at risk.

Speaking from an undisclosed location in Ukraine, Dr. Yana Terleeva, Head of TB at the Ministry of Health, described how planned expansions of new treatment protocols had to be abandoned as facilities were destroyed and staff shifted focus to war-related emergencies. “Instead of implementing a new TB treatment model, we are talking about military logistics,” she said ahead of World Tuberculosis Day on March 24.

Ukraine’s Success Undone by War

Over the last 15 years, Ukraine made remarkable progress in fighting TB—particularly multidrug-resistant TB (MDR-TB). The incidence rate dropped from 127 cases per 100,000 people in 2005 to 42.2 per 100,000 by 2020. In 2021 alone, Ukraine diagnosed and treated over 24,000 TB patients, including 5,000 with MDR-TB.

Before the conflict, the Ukrainian government had been independently procuring high-quality TB medications and diagnostics, integrating rapid molecular testing, and piloting next-generation treatments. Public health authorities had also built strong collaborations with civil society, enrolling patients in clinical trials and ensuring comprehensive care.

However, more than 135 hospitals have now been damaged or destroyed, including three major regional TB dispensaries. The World Health Organization (WHO) has confirmed at least 60 targeted attacks on healthcare infrastructure, including facilities central to TB care and medication storage.

“It is devastating to see these bombs destroying everything,” said Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership. “The progress made will take decades to regain.”

Displaced Patients, Interrupted Care, Rising Risk

Internally displaced people and refugees face additional challenges, including interrupted treatment and rising stigma. Civil society organizations like TB People Ukraine, a network of over 70 NGOs, are working tirelessly to locate displaced patients, offer humanitarian assistance, and ensure treatment continues.

“There’s an urgent need to ensure patients know where to go and that they have hope to continue treatment,” Dr. Terleeva said. “They need optimism—because they will one day return and help rebuild the country.”

Dr. Ditiu warned that due to crowding in shelters, poor nutrition, and extreme stress, TB—and particularly MDR-TB—is expected to rise in Ukraine. She also called on host countries to ensure TB patients among refugees are treated without stigma.

Neighboring countries like Romania have stepped up by offering diagnostics and treatment for Ukrainian TB patients. However, Poland, which has a much lower TB burden, may face more challenges due to limited TB-specific infrastructure. Additionally, the cost of TB medication in EU countries like Poland and Romania is significantly higher than in Ukraine, which sourced drugs at lower cost through global partnerships.

A Global Funding Crisis Looms

The crisis in Ukraine is unfolding as the global TB response faces a severe funding shortfall. In 2020, only $5.3 billion was available for TB care and prevention—less than half of the $13 billion needed annually. For research and development of new diagnostics, medicines, and vaccines, only $0.9 billion was available, compared to a $4 billion annual requirement.

With 90% of TB cases occurring in low- and middle-income countries, the disease continues to be underfunded and overlooked. The UN Sustainable Development Goal to end the TB epidemic by 2030 is in jeopardy, especially following the setbacks of the COVID-19 pandemic.

“We simply cannot continue to stand on the sidelines while people fall ill and die from a preventable and curable disease,” said Dr. Ditiu. “We need to recover from the COVID-19 disruption and accelerate progress—not backslide.”

Looking Ahead

The destruction of Ukraine’s national TB program is a stark reminder that health gains are fragile, especially in conflict zones. While the world grapples with emerging crises, TB continues to claim 1.5 million lives annually—making it the second deadliest infectious disease after COVID-19.

Continued support, global solidarity, and urgent investment in TB care, innovation, and infrastructure are not just essential for Ukraine—they are critical for the world.

Reference:
Health Policy Watch. (2022, March). Ukraine’s ‘Model’ TB Programme Destroyed by War, as Global TB Response Faces ‘Disastrous’ Funds Shortfall. Retrieved from https://healthpolicy-watch.news/ukraines-innovative-tb-programme-is-destroyed-as-global-tb-response-faces-disastrous-funds-shortfall