/ 14 November 2022

Africa can improve TB treatment – all it needs is political will

Mobile testing centres are part of the province's plan for getting diagnosis and treatment for chronic diseases out to the public
Mobile testing centres are part of the province's plan for getting diagnosis and treatment for chronic diseases out to the public

Tuberculosis (TB) is reclaiming the title of the world’s most deadly infection, even as the Covid-19 pandemic continues to kill an estimated 1 450 people daily. But this is not news to African countries, which is home to a third of the people globally who die from TB, even though they have less than a fifth of the world’s population.

And the real burden on the African continent might be worse. Only 60% of the estimated cases have been diagnosed and all the other infections are hidden by poverty, so the disease continues to spread.

Consider Zanyiwe’s story, who is recovering from TB for a fifth time. Her son-in-law died from the disease, and her 18-month granddaughter has it. TB has hammered her family and her neighbourhood in Cape Town — but this story could be set in Nigeria, Kenya or just about anywhere, because TB has never been contained in Africa.

Four years ago, there was hope that TB might be receiving the attention it deserves. The United Nations held a high-level meeting with heads of state in September 2018 where more than half of the world’s nations convened to rally support to tackle TB. Many pledges were made; fulfilment of these pledges got off to a slow start and then the Covid-19 pandemic derailed things.

The first commitment was to find and treat 40 million people with TB between 2018 and 2022, including 3.5 million children and 1.5 million people with drug-resistant TB. We’re 19% behind that overall goal, but 32% behind with children and 46% behind with drug-resistant TB. We now have new and shorter treatment regimens for TB and drug-resistant TB. Using these new technologies could make next year, when another UN high-level meeting on TB will convene, a different story.

The second commitment was to provide preventive treatment for 30 million people at risk for TB infections. We’re 48% behind. And we have already exceeded the sub-target of reaching six million people with HIV with preventive treatment. From 2018-21 we’ve only provided preventive treatment to 2.2 million household contacts of people with TB, 11.5% of the goal. 

Once again, we now have new, more effective and shorter preventive regimens to use — but we need the outreach capacity and willingness of countries to get the treatment into the hands of the people who need it.

The third and fourth commitments are about funding. Leaders pledged to spend a total of $13-billion annually on prevention, diagnosis and treatment by 2022. In 2021 only 42% of that yearly goal was spent. For TB research, $2-billion annually was pledged by 2022 but in 2021 research spending reached less than half that amount (46%). Rolling out the new treatments and developing even better ones will require a stronger embrace of these commitments.

But there have been signs of progress worth drawing attention to. First, Gabon, Kenya, Liberia, Namibia, the Republic of the Congo, Sierra Leone and Uganda made progress in finding more cases of TB last year. 

And the Central African Republic, Democratic Republic of the Congo, Mozambique, Nigeria, Tanzania and Zambia have all made progress throughout the pandemic, showing the political will needed to keep their people healthier. Overall, Africa found 4% more TB in 2021 than in 2020. It’s a start but we can do better.

New TB medicines are being supported by the World Health Organisation. Six-month therapy for drug-resistant TB has been approved in more than 20 countries, including the DRC, Mozambique, South Africa and Zimbabwe. And Ethiopia, Ghana, Kenya, Malawi, Mozambique, South Africa, Tanzania, and Zimbabwe are working to roll out new TB prevention treatments.

In Africa, we will not mistake these initial signs of progress for anything more significant. Yet, at the same time, it is still progress to be respected and built upon. Next year, the world will consider their long-ignored pledges. We need to show the world that it is time to move forward. All that’s been missing is the same thing that’s been missing for far too many years — political will.

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.