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Tuberculosis is a syndemic. Elimination strategies necessitate a syndemic approach that addresses the individual and societal vulnerabilities that determine whether we become infected, become sick, die, or recover with disability and a negative impact on our livelihoods. The WHO End Tb Strategy, a global initiative launched in 2015, exemplifies this syndemic approach. End TB outlines the fundamentals necessary to transform health determinants, promote disease prevention and early diagnosis with prompt treatment, and reduce transmission to save lives, prevent economic hardships, and reduce transmission. Nonetheless, even before COVID-19 was released, we were on track to miss all of our targets. Without a change in our approach to tuberculosis elimination, the situation is unlikely to improve. Two years after the global response to COVID-19 began, it is a good time to reflect on what the pandemic has taught us about our elimination efforts and ability to deal with threats to tuberculosis control. This article describes current threats to tuberculosis control and provides a harrowing synopsis of the impact of COVID-19 on tuberculosis.
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