Winning the War on Tuberculosis
Tuberculosis continues to kill millions around the world each year, especially in Africa. Eradicating the disease is possible, but only if African governments begin developing a multi-sector, integrated approach to containing and controlling it.
JOHANNESBURG – The world is finally waking up to the threat posed by one of the most overlooked diseases of our time. Last month, the United Nations General Assembly (UNGA) hosted the first-ever high-level meeting on tuberculosis (TB) to explore options for international eradication efforts. But, as welcome as this new global focus is, the fact remains that the road to beating TB begins in Africa.
Simply put, TB remains one of the deadliest epidemics in Africa today, and one-quarter of all TB deaths worldwide occur there. In 2016, some 417,000 people on the continent succumbed to the disease. Recent outbreaks of multidrug-resistant TB and extensively drug-resistant TB in South Africa, Mozambique, and Ghana could push the annual death toll even higher. These pockets of the bacterium, now completely immune to antimicrobial treatment, mean that the challenge of global eradication has become even more daunting.
Part of the reason for TB’s persistence is the vulnerability of the populations it infects. For starters, TB is among the leading killers of HIV-positive people, claiming some 40% of those who die from HIV. This poses dangers for non-HIV patients as well, especially those with suppressed immune systems, young children, and infants.
Eradication is also difficult because TB is a highly contagious airborne bacterium; people living and working in close quarters – such as miners, prisoners, migrants, and refugees – suffer the highest rates of infection. Finally, because TB prevalence is closely linked to poverty and social marginalization, reaching those most at risk is not always easy.
Infectious diseases have no borders, and as African countries deepen their trade ties and intra-Africa migration grows, the threat of regional pandemics will only increase. This makes it all the more critical that Africa begin developing a multi-sector, integrated approach to containing, controlling, and eventually eradicating public-health challenges like TB.
To this end, one approach that African governments could emulate is the TB management strategy in place for the continent’s mining sector, an inter-agency plan devised in 2014 by the Southern African Development Community. Although this so-called “harmonized” approach applies to a commercial industry, its focus on coordinating with the Regional Economic Communities (RECs) – African Union states grouped for economic integration – could serve as a model for more effective collective action on TB containment.
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But before a specific framework can be agreed upon, three issues require urgent attention. First, African health-care planners and disease specialists must set country, regional, and local containment targets. For example, setting goals for reductions in new TB infections would enable health officials to measure more accurately the impact of their strategies.
Moreover, to end TB completely, Africa will need new and sustained financial commitments from the public and private sectors. And, finally, disease-control strategies must be designed to support the economic and health-care priorities of the RECs. At the moment, most state and regional health-care systems lack funding and human resources. African policymakers must therefore develop systems for prevention, diagnosis, and care that help governments share the disease burden and ensure that treatment protocols are consistent across regions.
To be sure, there are some positive trends in the fight against TB. Global infection rates are falling by about 2% annually, and even African countries hit by TB still managed a 4% decline in infections from 2013 to 2017. And, with organizations like the World Health Organization and the African Union beginning to produce roadmaps for TB eradication, it is clear that momentum is steadily building.
Still, sustaining this progress in Africa will require significant regional coordination, not to mention a lot more money. Most vaccines and medications are currently too expensive for the majority of Africans. But even those lucky enough to obtain treatment – usually a six- to eight-month course of powerful antibiotics – still face a 20% chance of relapse.
The goal of eradicating TB is within reach; the recent gathering at the UNGA marked a critical turning point in the world’s war on the disease. But even as commitments are made and declarations signed, we must remember that in Africa, the battle is far from over.