Unless there is a complete overhaul of how tuberculosis (TB) is tackled, the world’s biggest infectious killer will claim lives for centuries – despite being preventable and curable.

So says the Global Plan to End TB, a five-year investment report released on Friday by Stop TB Partnership, an international organisation with 1 300 partners.

Statistics SA’s latest mortality study says tuberculosis is the country’s number one killer. In 2013 it resulted in more deaths than any other natural cause, including HIV and pneumonia.

The Stop TB plan, which South Africa implemented from this year, provides a five-year road map as a first step to reach the World Health Organisation’s (WHO) target of a tuberculosis-free world 2035. It aims to diagnose and treat 90% of all tuberculosis cases, especially 90% of those in populations with a disproportionately high number of cases, and for 90% of people to complete treatment.

Health Minister Aaron Motsoaledi, who chairs the partnership’s board, said in a statement that these targets are set to “smash the status quo” by guiding upscaled tuberculosis care, which he believes should extend beyond hospitals and clinics and into residential areas to address how the disease thrives where overcrowding and malnutrition are common.

“TB has always been a disease of poverty and a litmus test for our commitment to social equality and health for all.” Motsoaledi said that to achieve the 90-90-90 targets, social support for patients is essential, as is a shift in focus to disproportionately affected populations, such as children, mining communities, migrants and prisoners.

Stop TB says $56-billion is needed globally to treat 29-million patients, save 10-million lives and prevent 45-million cases by 2020.

Currently, global tuberculosis rates decrease by 1.5% a year. At this rate, it will take more than a century to reach WHO targets. The plan says an annual decrease of almost seven times faster – a 10% decrease – is needed to reach the targets by 2035. The organisation estimates there is a global shortfall of $7.4-billion necessary to achieve the plan’s goals.

Lucica Ditiu, who heads the partnership, said funding must be prioritised. “It is a global disgrace and human tragedy that TB kills – a curable disease – around 1.5-million people a year and nobody speaks about ending it,” she said.

If funds become available it would translate into one of the “highest returns on investment of any health intervention”.

“We know it can be done, we know how it can be done, we know how much it will cost us – we need to have the desire to do it”, she said.

SA’s TB stats are too high

• South Africa has the world’s second-fastest-growing tuberculosis epidemic – after Lesotho.
• Everyone diagnosed with HIV in South Africa is tested for the disease. 
• Between 60% and 70% of tuberculosis patients are also HIV positive. 
• The World Health Organisation’s target for the percentage of people who successfully complete TB treatment is 85%, but South Africa falls short of this with 78%. Differing data from the National Institute for Communicable Diseases estimates the figure at 90%. 
• But an estimated quarter of people who test positive for TB don’t start treatment and remain infectious in their communities.
• South Africa has the third-highest TB-diabetes co-infection rate. Annually 75 000 local diabetics develop tuberculosis. 

Source: WHO 2015 Global TB Report, StopTB global plan to end TB, Shabir Madhi of the NICD

See “Undercover tuberculosis: How SA’s top killer slips in under the radar”