SA's TB burden continues to grow as Covid-19 gets all the attention

29 September 2021 - 06:00
By Sipokazi Fokazi
A new study warns that plans to end TB by 2030 will not happen because funds were diverted to fight the Covid-19 pandemic.
Image: 123RF/ANDRIANO A new study warns that plans to end TB by 2030 will not happen because funds were diverted to fight the Covid-19 pandemic.

Tuberculosis, which remains the leading cause of deaths in SA, is on the rise. And, to make matters worse, there is little hope of ending it in the next nine years, as envisaged by the UN, largely thanks to the Covid-19 pandemic, which has taken attention away from the “orphan disease”. 

According to the latest report by an international organisation the Stop TB Partnership, during the coronavirus pandemic TB funding was slashed by more than half. This means that at least 1.2-million people either weren't diagnosed with, or treated for, TB. With four months still left this year, the number is expected to rise further.

In 2020, only 5.7-million people received treatment for TB, a drop of 21% from the previous year — leaving an estimated 4.3-million people with untreated TB and spelling death for probably half that number.

The latest research, which analysed the affect of Covid-19 in 27 countries, found that the dismally low levels of funding represent the main barriers to achieving the UN’s sustainable development goals (SDGs) of ending TB by 2030. Now, only $6.5bn per year is available for the TB response globally, less than half of the commitments made at the UN’s first high-level meeting on TB in 2018.

In the report experts refer to TB as an “orphan disease” due to the lack of political will and chronically low budgets for fighting it.

In the report released on Tuesday, the Stop TB Partnership warned that getting the TB response back on track will require at least a doubling of resources now being provided to the fight against the disease, including a significant increase in the share of its resources by the Global Fund, which also plays a leading role in the global response to the Covid-19 pandemic.

“We always knew that ending TB by 2030 was going to be an uphill battle, but Covid-19 and the reduced funding for TB have sent us rolling further down the hill than anyone could have expected,” said Dr Lucica Ditiu, executive director of the Stop TB Partnership.

“Years of chronic neglect have led to an unbearable situation in which TB kills more than 4,000 people a day, more than HIV and malaria combined. Yet too few decisionmakers, donors and stakeholders care about TB. It is not that we will see future consequences ...we are in the middle of the disaster, and our attention seems to be in the very wrong place. Data from 2020 and 2021 will reveal soon how hundreds of thousands of additional people are dying from TB and how TB drug resistance and the TB epidemic itself are on the rise,” Ditiu said.

Dr Lucica Ditiu, executive director of the Stop TB Partnership, says while ending TB in 2030 was always going to be uphill, reduced funding due to Covid-19 has made the target even more remote.
Image: Supplied Dr Lucica Ditiu, executive director of the Stop TB Partnership, says while ending TB in 2030 was always going to be uphill, reduced funding due to Covid-19 has made the target even more remote.

According to the latest Stats SA (Stats SA) mortality report data for 2016-2018 TB has remained the leading cause of death in SA while diabetes remained the second leading underlying cause of death.

Diabetes mellitus, the report found, remained as the second leading underlying cause of death whose proportions have been increasing over the three years.

TB was the leading underlying cause of death for males, accounting for 7.2% of male deaths while the diabetes mellitus was the leading underlying cause of death among females accounting for 7.7% of female deaths. HIV was the leading causes of death among men while cardiovascular diseases was the second leading underlying cause of death for females.

Based on available TB notification data, the Stop TB Partnership anticipates that the world will fail to achieve the 2018 UN targets of diagnosing and treating 40-million people with TB in the period 2018-2022. Global projections, based on data from 27 countries representing about 73% of the global burden of TB, show that less than 85% of this target will be achieved.

“While 85% might sound like an achievement, what it means in practice is that more than 5-million people with TB will be left behind without treatment. Untreated TB translates into about a 50% mortality rate, and those who survive will not only suffer the consequences of the disease but will also spread TB to many more, perpetuating the cycle of transmission,” Ditiu added.

Dr Tereza Kasaeva, director of the World Health Organisation (WHO) global TB programme, said the affect of the Covid-19 pandemic has been severe, reversing hard-won gains in the fight against TB. But this was not a moment to lose hope, “but to redouble commitments and action for the sake of the millions who face immense suffering and lose their lives to this preventable and curable disease”.

The report says the biggest external donor to TB programmes, the Global Fund, only allocates 18% of its resources to TB, even though the disease causes more than half of the deaths from diseases served by the Global Fund. In 2019, 1.4-million people died from TB, more than HIV/Aids that caused 700,000 deaths, and malaria that resulted in 410,000 deaths.

Of the available funds for the fight against TB, 85% comes from domestic budgets. Low-and middle-income countries (LMICs) remain heavily dependent on the Global Fund for TB services, clearly putting the Global Fund under the spotlight to significantly increase its funding portion to close the huge gap.

Austin Obiefuna, vice-chair of the Stop TB Partnership board, said: “If we want to end the TB epidemic, people affected by TB must be at the centre of the response. Countries must step up their efforts to conduct assessments and develop action plans to transform their TB response into one that is equitable, rights-based, gender-transformative and people-centred.

“Despite being one of the leading infectious disease killers in the world, TB remains an orphan disease, never a political priority and never high up on funding agendas. To avoid further setbacks to the TB response, recover from losses experienced over the past year, and ensure that the Global Fund’s allocations are in line with TB’s share of disease burden and deaths, the Global Fund’s financial contribution for TB must be at least doubled,” Obiefuna said.