It is interesting to see, from my perspective in South Africa, the reaction to the slight increase in tuberculosis (TB) cases in the United States.
They had declined steadily since the early 1950s but, in recent years, have slowly begun to rise.
However, while the rates 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 countries with the highest TB burden.
But for several years, the World Health Organization’s (WHO) annual tuberculosis report has shown progress in Africa: Incidence is falling and more infections are being diagnosed and treated. And TB deaths have declined almost every year this decade.
This is amazing. SSA makes major inroads despite huge burden as US shows how disengagement from public health allows disease to wipe out everyone’s well-being.
African governments are shaping up to have a remarkable impact. Consider the disease situation in three of Africa’s most populous countries, in light of the US numbers, and how they are scaling up their efforts.
Tuberculosis detection services
In Kenya, the incidence of TB has fallen over the past 14 years with deaths at a third of 2010 numbers. The government says it will increase treatment coverage and multi-drug TB detection services.
In Nigeria, as of 2018, the incidence of tuberculosis remains stable as deaths have decreased by 38%. The government has stepped up efforts to detect and treat individual cases before they spread — 26 percent more cases were reported last year than in 2022.
In South Africa, TB incidence has fallen steadily since 2010, and deaths have slowly declined after sharp falls in 2012 and 2013. The state funds nearly 75 percent of its TB services and is launching an HIV control panel and tuberculosis to better track statistics.
Innovations in TB research and development have helped improve outcomes. A treatment for highly drug-resistant forms of the disease, developed by the TB Alliance, was recommended by the WHO in late 2022 and is available in low- and middle-income countries through the UN World Drug Facility. More than 70 countries are in various stages of adoption and implementation.
Money saved from developing the new treatment regimen can be channeled back into TB prevention, detection and treatment services.
Projections show that this regimen, which is more cost-effective and shorter, would save $740 million worldwide each 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 for TB control could be significant.
Much more is needed though. At a key high-level UN meeting last September, member states agreed to spend $5 billion a year on TB research and development, but spent only 20 percent of that by 2022.
They also agreed to allocate $22 billion annually to TB diagnosis, treatment and prevention services by 2027, but spending was just $5.8 billion last year.
WHO estimates that over two-thirds of TB patients and their households in SSA face devastating economic costs.
In addition to the direct costs of medical care and the costs of getting to and from treatment, TB reduces patients’ ability to work, and time spent caring for patients reduces what could have been spent earning income.
We cannot have sustainable economic growth if TB is eating away at both the health and the livelihood of our families. Instead, if governments focus on ending TB and invest in this goal, we can get more people out of poverty while improving health.
Tuberculosis 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 it a reality.
Dr Olugbosi is senior director, clinical development, at TB Alliance