"Khayelitsha has one of the highest TB burdens globally, and health care professionals work long hours to help patients fight the deadly lung infection." (David Harrison, MG)

If SA wins the fight against TB, the world will benefit

Gilla Kaplan
South Africa lost nearly 100 000 people to TB last year – three-quarters of whom were HIV-positive. Reducing the burden will benefit the economy.

The Cape Flat’s Khayelitsha, which stretches from the Driftsands Nature Reserve to the shores of False Bay, and is home to nearly half a million people, offers a window into a serious and complex public health epidemic facing South Africa and the world: tuberculosis (TB). Khayelitsha has one of the highest TB burdens globally, and health care professionals work long hours to help patients fight the deadly lung infection.

Just kilometers away in downtown Cape Town, thousands of scientists, policymakers and advocates are gathering this week to discuss tuberculosis at the 46th Union World Conference on Lung Health. Experts and leaders will share research on the latest approaches and tools, and launch an ambitious global plan to sharply reduce the number of new TB cases and deaths.

The Cape Town gathering on TB could not come at a more important moment, or be held in a more important place. Tuberculosis is one of humanity’s cruelest diseases. According to the World Health Organisation’s 2015 Global Tuberculosis report, South Africa lost nearly 100 000 people to TB last year, three quarters of whom were HIV-positive. TB is curable, but too often effective care does not reach people who need it. This allows TB, an infectious disease, to spread. In South Africa, prisoners and miners are two groups who battle some of the highest rates of TB transmission in the world.

While it is difficult to bring down high TB rates, it is not impossible, as South Africa is showing through leadership, innovation and collaboration. 

Health Minister Aaron Motsoaledi recently launched a four-year campaign to help 5 million people in high-risk communities know if they have TB or not, an essential first step to connecting those with the disease to care. And earlier this year, the government pledged to improve TB treatment for miners and their families, an effort that received a boost in funding thanks to a regional initiative from the Global Fund to Fight Aids, TB and Malaria.

These initiatives must be bolstered by innovation. South Africa is already leading the charge to adopt breakthrough technologies for TB such as GeneXpert, which allows health workers to diagnose the most complex cases in hours instead of weeks. The country’s brilliant scientists and world class universities are helping accelerate development of much-needed new tools to fight TB, including drug regimens that are safer, less toxic and better at improving cure rates. South African expertise and capacity to conduct clinical trials will be essential in the search for an effective vaccine to prevent the disease. 

If maintained, South Africa’s TB initiatives hold tremendous promise to save lives. They offer a model for how to identify and keep track of more patients who need care, introduce and encourage uptake of new innovations, and ultimately reduce the number of people who fall ill or lose their life to TB. The disease does not respect borders, meaning that coordination across national, provincial and local levels is critical to staying ahead of the epidemic.

South Africa has a vested self-interest in the fight against TB. In addition to saving lives, reducing the burden can boost productivity and benefit the economy. For example, according to an ongoing World Bank study, the mining sector alone loses more than 9 million work days each year to the disease. South Africa also has the opportunity to help address some of the toughest challenges facing the global TB response. 

Long after the conference ends, Khayelitsha will continue to face some of the most daunting challenges of any community in the world. Defeating TB under those circumstances will require unprecedented levels of coordination and a sophisticated response using every tool available. Fortunately, South Africa has the capability to do precisely that. 

Success in South Africa means success for the world — and it is within reach.

Gilla Kaplan is the director of the tuberculosis program at the Bill & Melinda Gates Foundation. The foundation supports several TB projects in South Africa.

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