Foundation essay: This article is part of a series marking the launch of The Conversation in Africa. Our foundation essays are longer than usual and take a wider look at key issues affecting society.
Tuberculosis (TB) has travelled with mankind since the Pharaohs. In the 21st century, the TB scourge has made a strong resurgence, exacerbated by the human immunodeficiecy virus (HIV) epidemic that has gripped the globe in all regions, especially sub-Saharan Africa. But with it has come fresh opportunity and a vision to finally eradicate TB from the planet.
The bacterium that causes TB, Mycobacterium tuberculosis, is common, particularly so in poorer socioeconomic communities with dense living conditions. According to the World Health Organisation (WHO), about two billion people worldwide are infected with TB. It spreads primarily by droplets sprayed out when an infected person coughs or sneezes, explaining why it thrives in close communities.
These communities include extended family homes, dormitories, hostels, mines and prisons. Migrants and refugees are particularly vulnerable due to the poor socioeconomic conditions that they often have to work with.
Dealing with a modern disease in a old way
The resurgence of what was thought of as a low-key health problem is due to the global epidemic of HIV. HIV weakens the immune system and gives TB the opportunity to overcome the body’s defences and destroy it, usually attacking the lungs.
Globally, TB claims the lives of 1.5 million people every year, two-thirds of whom are HIV-infected. In Africa, TB is now the leading cause of death in HIV-infected people. These statistics are exacerbated by the spreading of the multi-drug resistant TB, and the extensively drug-resistant TB. These two strains are caused primarily by the inadequate treatment of ordinary TB and is much more difficult and expensive to treat.
The unprecedented international effort to address HIV has given rise to a renewed interest in combating TB. Until the early 2000s, TB last saw a new drug for treatment more than 40 years ago. Currently, doctors still, in the main, rely on a more than 100-year-old microscope diagnostic technology to detect TB. The mainstay of treatment is a cocktail of four old drugs over a period of at least six months.
The research effort and funding aimed at dealing with AIDS has seen HIV go from a universally fatal illness to a manageable chronic disease with proper access to care and treatment. As a spin-off from that work, new TB drugs are emerging and more rapid and certain TB tests are developing.
The plan to tackle TB
Improved screening and testing methods, enhanced monitoring of the disease and patients, tracing of TB contacts, and providing access to effective drugs has seen its overall burden of disease decrease globally.
But this is not enough. The problem remains one of scale and will. Although TB is treatable and completely curable, there are more than 24,000 new cases of TB around the world daily. Nearly four in ten of these cases are missed and go without testing or treatment. These people in turn infect ten others in a year. Other challenges include taking too long to make a diagnosis or to treat someone.
The WHO has set a bold goal of virtually eliminating TB as a global pandemic by reducing 95% of TB deaths by the end of 2035.
However, to achieve this, every TB patient must have access to effective diagnosis, treatment and cure. Innovative prevention methods, diagnostic tests and treatment tools and strategies must be developed and sped up. And lastly, researchers and drug developers globally must collaborate and co-ordinate their efforts.
This objective is no easy task. There is no magic bullet to beat this disease. An effective vaccine would bolster the achievement of the 2035 goals. But first, a viable vaccine needs to be developed. Exciting work is emerging in this pursuit.
Beating TB will require sustained and improved efforts in preventing and treating the disease. Discovering new approaches to TB requires funding for research and in the same order of magnitude that has been spent on research into HIV.
Learning the lessons from other outbreaks
It is estimated that more than US$2 billion is needed annually to properly research and develop new tools and approaches to manage TB. Funding covers only one-third of this. Making funds available requires political and social will and a compelling economic case.
The economic case is relatively easy to make. It costs as little as $100 to treat drug-sensitive TB but as much as $100,000 to treat a multi-drug resistant case. Prevention costs a paltry $20 in some countries.
Since the route to multi-drug resistant TB is through failed prevention and poor treatment of the drug-sensitive strain, making funding available for proper prevention and first-line treatment is economically sound. $100,000 spent on prevention of TB disease in 5000 people potentially helps avoid 50 cases of multi-drug resistant TB, which would cost $5million to manage.
There are also additional direct costs to health care and loss of income and productivity costs that affect individuals and nations alike.
The battle against HIV over the past 20 years has shown what can be done when there is effective global mobilisation of resources and effort. The recent global response to the outbreak of Ebola in West Africa is also evidence of what can be done when the world responds to a health threat.
The successful campaign against smallpox proves that disease eradication is not just a pipe dream. The required levels of funding can be made available if we are serious about erasing the scourge of TB from the planet.
TB is treatable and curable. It can be eradicated from the planet if we have the will. Modern science, political capital and social drive can make this possible.
The Aurum Institute receives funding from, inter alia: The US Government PEPFAR programme through the US Centers for Disease Control and Prevention, The Bill & Melinda Gates Foundation, and The Global Fund through the SA Department of Health. Dr Dave Clark is employed by The Aurum Institute NPC, affiliated with the University of the Witwatersrand and other academic organisations globally.
Salome Charalambous works for The Aurum Institute, that receives funding from organisations including the US Centers for Disease Control and Prevention, The Bill & Melinda Gates Foundation, and The Global Fund through the SA Department of Health.
Authors: The Conversation