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TB reporting plummets in SA and country will likely pay a heavy price

15 October 2020 - 14:33 By Siphokazi Fokazi
A patient with extensively drug-resistant tuberculosis at Jose Pearson Hospital in Port Elizabeth, Eastern Cape. A new global TB report says SA is one of the nations that have dropped their TB reporting during the lockdown.
A patient with extensively drug-resistant tuberculosis at Jose Pearson Hospital in Port Elizabeth, Eastern Cape. A new global TB report says SA is one of the nations that have dropped their TB reporting during the lockdown.
Image: Chris Frey

SA is one of the countries that will pay a heavy price as a result of Covid-19, not only due to the economic losses the country has experienced, but also because the leading killer disease tuberculosis is set to worsen due to neglect during the lockdown.

According to the Global TB Report 2020, released by the World Health Organisation (WHO) on Wednesday, SA’s monthly TB notifications dropped below 50% by June — meaning that thousands of TB carriers could be transmitting the bug in their communities.

Authors noted that the pandemic threatens to reverse progress made to reduce the global burden of TB. The report warns that if action and investments are not made urgently, global targets for prevention and treatment will likely be missed.

The report has put SA in the top eight countries carrying the world’s TB burden and which account for two thirds of the global total cases. The countries are India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and SA (3.6%).

Meanwhile, a new report by a team of researchers from Harvard University and the University of California, which is due to be released next week at the 51st Union World Conference on Lung Health, is to show the economic and human cost of not ending TB by the UN target of 2030.

It says the likely date of 2045 will come at a huge price tag of $3-trillion (R50-trillion). This figure includes losses in income growth and the societal value of some 5.7 million avoidable TB deaths in 120 countries.

Covid-19 “has been a bitter pill to swallow” and the brief shutdown of TB programmes due to the pandemic will have “calamitous epidemiologic and economic consequences”, the report states.

“Millions of people’s lives are at stake in the short term, and in the long term they also potentially face the risk for developing new drug resistance to TB, with much poorer outcomes. We cannot forget communities in low- and middle-income countries that are being doubly hit by the pandemic and the crisis of TB,” the union noted in a statement.

Apart from the non-testing of TB at health centres, the authors of the WHO TB report have also warned that the loss of income could increase the percentage of people with TB as unemployment and undernutrition are key drivers of TB.

The report says SA, India, Indonesia and the Philippines, which account for 44% of the global TB cases, experienced the largest drops in the reported number of people diagnosed with TB between January and June.

About 1.4 million people died from TB-related illnesses in 2019 and over 60,000 of these are from SA. Of the estimated 10 million people who developed TB that year, some 3 million were either not diagnosed or were not officially reported to national authorities.

Dr Tedros Adhanom Ghebreyesus, director-general of WHO, said the report showed that: “Equitable access to quality and timely diagnosis, prevention, treatment and care remains a challenge. Accelerated action is urgently needed worldwide if we are to meet our targets by 2022.”

Even though TB incidence globally has been falling before Covid-19 and progress towards meeting the 2020 milestones of reducing TB by 20% between 2015 and 2020 has been made, the report warns that this is not fast enough with many high TB burden countries not on track. The cumulative reduction from 2015 to 2019 was 9% (from 142 to 130 new cases per 100,000 population) and a 14% drop in deaths.

While the European region has almost reached the 2020 milestone, with a reduction of 19% in the TB incidence rate, the African region has also made good progress, with a reduction of 16%. 

SA is among the seven high TB burden countries and a total of 78 countries globally that had already reduced their new TB cases by 2020. Other high TB burden countries that have achieved reducing new cases are Cambodia, Ethiopia, Kenya, Namibia, Russia and  Tanzania, while Lesotho, Myanmar and Zimbabwe “are on track”.

It is not all doom and gloom though. The WHO report says countries, including SA, were increasingly strengthening infection control measures and were using digital technologies “to provide remote advice and support”. 

“To reduce the need for visits to health facilities, many countries are encouraging home-based treatment, all-oral treatments for people with drug-resistant TB, provision of TB preventive treatment, and ensuring people with TB maintain an adequate supply of drugs,” said Dr Tereza Kaseva, director of WHO’s Global TB Programme.

“In the face of the pandemic, countries, civil society and other partners have joined forces to ensure that essential services for both TB and Covid-19 are maintained for those in need. These efforts are vital to strengthen health systems, ensure health for all, and save lives.”