South African health minister: strong alliances needed to end TB

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Aaron Motsoaledi: 'Drug resistant TB gobbles up more than a third of South Africa’s treatment budget'

It is a challenging time to be the health minister for South Africa, and to chair the Stop TB Partnership. Nearly 9m people fell ill with tuberculosis in 2012 around the world. More than 1m died. We are not reaching the vast majority of people who are at risk.

Rising drug resistance to TB is a global security threat. We cannot fight this problem without new tools. Some of our drugs are more than 40 years old and people continue to be diagnosed using techniques from the last century. Alas, we have a funding gap upwards of $1.35bn every year for research and development.

We need another $2bn a year to help treat TB. Governments, donors and civil society groups must work together.

In South Africa, we know that TB is not just a health issue. It hurts our economy. We are expanding our health services, especially to fight the traditional diseases of poverty, such as TB and HIV/Aids. This World TB Day I salute the progress we have made, while warning of the miles we must still travel to beat this terrible disease.

Let us not underestimate the size of the problem: TB has been with us so long, and has remained so deadly, that the global TB pandemic has killed 1bn people – more than all other diseases combined.

Africa accounts for about 40 per cent of all TB deaths. Those who suffer most are at the margins of society: the malnourished, refugees, and other vulnerable groups. Poverty, financial barriers, and the absence of health services means these people not only suffer from TB, but are being missed by the health systems that could offer them treatment.

One of the biggest barriers is finding those not being reached. Of the 9m people developing TB each year, more than 3m are not diagnosed. We must focus on “hotspots” of high TB transmission and low cure rates.

In South Africa we have identified three particularly vulnerable communities: the prison population; mine workers; and people living in peri-mining communities. During the 2013 World TB Day South Africa released guidelines on infection control for prisons and deployed the first GeneXpert machine in a prison to ensure rapid diagnosis and treatment of drug sensitive and drug resistant TB, In addition, routine screening of inmates on admission and release for TB and testing for HIV is currently being rolled out to all prisons. Contact tracing for newly incarcerated inmates – screening of their families has also commenced.

More than 30 per cent of TB infections in southern Africa can be attributed to mining. Prevalence can be as high as 4,000-7,000 cases per 100,000 people – 20 times the global average and 10 times that of the region.

Factors ranging from exposure to silica dust and poor living conditions, put miners at high risk. They are also often on the move, taking TB to those close to the mines and to miners’ home communities. This constant movement is the most significant challenge we face to ensure miners access healthcare and complete their treatment.

Mining generates 60 per cent of southern Africa’s foreign exchange reserves and 10 per cent of regional GDP. One only has to look at the medical costs, revenue and productivity losses, and lost wages to see the immense drag on economic growth.

While mining companies have programmes to detect and treat miners for TB and HIV, this is available only to mine workers and not the communities in which these miners live. Additionally, there is no system to ensure continuity of care for miners when they go home for vacation or when their contracts end.

With support from the World Bank and others including The Global Fund and the Stop TB Partnership, South Africa this week hosts a ministerial level meeting with companies and worker representatives to consider ways of securing for migrant miners the best possible care whether they are on the mines in South Africa or when they return to their homes in neighbouring countries. We hope to agree on a true public health response to both TB and HIV as these diseases do not respect borders!

We must come together to help other vulnerable groups. Undetected TB has led to an explosion in difficult, and sometimes impossible to treat drug-resistant cases worldwide.

By finding the missing 3m and giving them quality care we can halt the rise of drug-resistant TB. Although this accounts for only 3 per cent of the cases we treat, it gobbles up more than a third of South Africa’s treatment budget. Poor countries with high rates of drug-resistant TB cannot tackle it alone. The human and economic costs of not doing enough to combat TB is simply too grave to accept.

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The writer is South Africa’s health minister