Africa now has momentum on TB; let’s not squander it

It is interesting to see, from my vantage point in South Africa, the reaction to the slight rise in tuberculosis (TB) cases in the United States.

They had declined steadily since the early 1950s but, in the past few years, started to slowly increase.

However, while the percentages seem steep, the overall increase is less than 1,300 new cases.

In contrast, the disease has long been a crisis in Sub-Saharan Africa (SSA), with 17 of the highest TB burden countries.

But for several years now, the World Health Organization’s (WHO) annual TB report shows progress in Africa: Incidence is declining and more infections diagnosed and treated. And TB deaths have declined almost every year this decade.

This is stunning. SSA is making important inroads despite a tremendous burden as the US shows how turning away from public health allows diseases to chip away at everyone’s prosperity.

The stage is set for African governments to have a remarkable impact. Consider the state of the disease in three of the most populous African countries, in light of the US numbers, and how they are increasing their efforts.

TB detection services

In Kenya, TB incidence has declined over the past 14 years with deaths at a third of 2010 numbers. The government says it will increase treatment coverage and multi-drug resistance TB detection services.

In Nigeria, since 2018, TB incidence has held steady as deaths declined 38 per cent. The government has intensified efforts to find and treat individual cases before they can spread — 26 per cent more cases were reported last year than in 2022.

In South Africa, TB incidence has steadily fallen since 2010 and deaths slowly declined after steep drops in 2012 and 2013. The statefunds almost 75 per cent of its TB services and is launching an HIV and TB dashboard to better track the statistics.

Innovations in TB research and development have helped to improve outcomes. A treatment for the highly drug-resistant forms of the disease, developed by TB Alliance, was recommended by the WHO at the end of 2022 and is available to low- and middle-income countries through the UN’s Global Drug Facility. More than 70 countries are in various stages of adopting and implementing it.

The monies saved from deploying the new treatment regimen can be channeled back into TB prevention, detection and treatment services.

Projections indicate that this regimen, which is more cost-effective and shorter, would save $740 million globally every year if all eligible patients received it.

Treatment and prevention

Other new treatments, diagnostics and vaccines are on the horizon. The impact of safe, shorter, effective and cheaper tools to control TB could be significant.

Much more is needed though. At a key UN high-level meeting last September, member states agreed to spend $5 billion yearly on TB research and development yet they spent only 20 per cent of that in 2022.

They also agreed to put $22 billion yearly into TB diagnostic, treatment and prevention services by 2027 but spending was only $5.8 billion last year.

WHO estimates that more than two-thirds of TB patients and their households in SSA face catastrophic financial costs.

Besides the direct cost of medical care and that of getting to and from treatment, TB saps the ability of patients to work and the time spent taking care of patients detracts from that which could have been spent earning an income.

We cannot have solid economic growth if TB is eating away at both the health and livelihoods of our families. Instead, if governments focus on ending TB and invest in this goal, we can lift more people up and out of poverty while improving health.

TB must be a priority. It is past time to end the TB crisis, and it is now possible. But all governments need to step up and make this a reality.

Dr Olugbosi is senior director, clinical development, at TB Alliance