This World TB Day, celebrations are going virtual. But South Africa has reason to celebrate its gains — and put them to a new test.
As South Africa, we are joining the world to commemorate World TB Day on 24th March, under the local theme, “Cheka Impilo, It’s Time to End TB!” This year’s commemoration will be different following the announcement that all big events would be cancelled due to the coronavirus outbreak. This is in realising the seriousness of this outbreak as well as the rapid spread of the virus on our own soil. President Cyril Ramaphosa has declared the outbreak a national disaster and activated the Disaster Management Act. This World TB Day will be commemorated differently — with several digital / media initiatives throughout the country. In contrast to the new coronavirus, TB was declared a global health emergency by the World Health Organisation (WHO) in 1993.
Each year, we commemorate World TB Day to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic. The date marks the day in 1882 when Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards more research in diagnosing and curing this disease.
In South Africa, TB continues to be a leading cause of natural death, according to Statistics South Africa, and the leading cause of death amongst people with HIV globally, UNAIDS figures show. TB is a major public health concern and is responsible for the death of 175 people in the country every day — almost two-thirds of these deaths were among people living with HIV, shows the WHO’s 2019 global TB report.
And more than 300 000 fell sick with TB in the same year. Our country is one of only seven nations estimated to have more than 500 cases of TB per 100 000 people.
But there has been a considerable decline in the number of people who fall sick with TB. The total reduction in TB incidence between 2015 and 2018 was 6.3%, according to the WHO Global TB Report 2019. The decline in TB incidence in South Africa over the past decade is attributed largely to the broad roll-out of antiretroviral therapy which is a huge achievement of government. With more than seven-million people with HIV, South Africa also has the highest number of people on antiretroviral therapy.
South Africa has shown commitment to health research and development (R&D). South Africa is making strides to realise the African Union target to allocate 1% of GDP to R&D, as currently that rate is estimated at 0.8%. In response to TB, South Africa has spearheaded the use of the few new important health technologies that have entered the market in recent years, which included:
- South Africa was one of the first countries to implement the GeneXpert TB test following recommendations by the WHO. GeneXpert significantly reduced the turn-around times for TB
- South Africa is the first country in the world to take the bold step to ensure that no one with drug-resistant TB is denied access to better drugs by scaling up access to an effective new drug, making multidrug-resistant TB treatment more tolerable
- A recent study shows that it’s possible to prevent people with HIV from developing active TB disease. The study showed that it is safe to administer antiretroviral therapy combined with a preventive TB treatment commonly known as the 3HP to people living with HIV
- Research also suggests that the two new TB drugs that have emerged recently, bedaquiline and delamanid, can be administered together safely. This has important implications for creating new treatment options for drug-resistant TB.
As with all health conditions, the prevention of TB is always better than a cure. TB is an airborne infection; TB bacteria are released into the air when someone with infectious TB coughs or sneezes. The risk of infection can be reduced by using a few simple precautions as follows:
- good ventilation: as TB can remain suspended in the air for several hours with no ventilation
- natural light: ultraviolet light kills off TB bacteria
- good hygiene: covering the mouth and nose when coughing or sneezing reduces the spread of TB bacteria.
In healthcare settings, the spread of TB is reduced through the use of protective masks, ventilation systems, keeping potentially infectious patients separate from other patients, and the regular screening of healthcare workers for TB.
Early diagnosis and treatment is the most effective way to prevent the spread of TB, therefore, a person with diagnosed with TB must be started on treatment. The majority of patients are no longer infectious after just two weeks of taking the medication.
The coronavirus spreads in droplets that are sent into the air when someone with the virus coughs or sneezes. If you are nearby, you could breathe these droplets in. The droplets can also land on surfaces where they may be picked up by your hands. If you then touch your face you could become infected with COVID-19 caused by the Sars-Cov-2 virus.
For both TB and the new coronavirus there are lots of simple but effective measures that you can take to protect yourself.
- always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands or use a sanitiser gel
- wash your hands more often than usual, for 20 seconds each time with soap and water or hand sanitiser, especially when: you get home or into work, blow your nose, sneeze or cough, eat or handle food
- avoid touching your eyes, nose and mouth with unwashed hands
- avoid close contact with people who are unwell.
Complementary COVID-19 and TB responses can assist in curbing both epidemics to save lives. Both diseases can utilise the capacity-building efforts, along with surveillance and monitoring systems and robust programmes and infrastructures that have been developed over many years of investment by national government and donors, as well as the use of diagnostic tools such as GeneXpert and chest radiography. COVID-19 testing has been initially focusing on those with a history of travel to affected areas. However, with local transmissions, similar to TB, the case-finding strategies are being modified to an active approach, including the testing of symptomatic individuals and their close contacts.
Many practices in the TB response, such as triaging in the health centre setting, cough etiquette, contact tracing in the community, infection control in health centres and the community, including isolation, would benefit the COVID-19 response. In many settings, the TB response, which includes community volunteers, may be activated for awareness-raising, prevention and early notification in COVID-19. In both diseases, the frontline health care workers need to be well trained, equipped, protected, supported and enabled to care for their patients.
Investments into National Health Insurance, health R&D and a strong political will are essential if the fight against COVID-19, HIV, TB and other diseases is to be won. It is the responsibility of every citizen to ensure that we live healthy lives, prevent disease and we seek health care at the earliest possible instance.
As we confront the challenges brought by TB, and recently by COVID-19, it is becoming clearer that the current tools for fighting these diseases are not enough and more needs to be done. There is a need for the country to continue investing in stronger health systems and ensuring that people are able to access quality health care services on time and people have the knowledge and means to prevent the occurrence of disease in the first place. Therefore, there is a greater need to invest in research and innovations that will benefit both diseases to develop effective vaccine and new medicines.
The COVID-19, like TB, reminds us of the importance of prioritising health and allocating financial and human resources for universal health coverage and addressing the needs of vulnerable populations. World TB Day should be a unique opportunity to campaign for both diseases and to address all health threats, whether new or old.
Under the theme “Cheka Impilo, It’s Time to End TB!”, the spotlight this year is on urgently accelerating the TB response to save lives and end suffering, building on high-level commitments by Heads of State at the 2018 UN High-Level Meeting on TB. In the words of former Statesman, Nelson Mandela: “We can’t fight AIDS unless we do much more to fight TB as well.”
Hon. Dr Sibongiseni Dhlomo is a Member of Parliament and the Chairperson of the Portfolio Committee on Health. He was the MEC for Health in KZN from 2009 – 2019