London - The world’s focus may be centred on climate change and its devastating effects on the environment, health, economy and society.
But in the shadow of COP27 in Sharm el-Sheikh, Egypt, old enemies keep resurfacing which pose an equally existential threat, especially to those afflicted by them.
The latest WHO 2022 Global Tuberculosis (TB) Report, released just before the start of the COP27 jamboree, reveals a disturbing regression which some gatekeepers of global health euphemistically spin as “stalling progress” given that 26.3 million people were treated for the disease between 2018 and 2021, albeit still far short of the 40 million target set for 2018–2022 at the UN High-Level Meeting on TB.
The data of disease management dysfunction and reality is that an estimated 10.6 million people fell ill with TB in 2021, up 4.5% from 2020; and 1.6 million people died from TB (including 187 000 among HIV-positive people).
Here’s the catch: though the WHO End TB Strategy 2025 Milestones envisage a 75% reduction in the number of TB deaths in the world between 2015-2025, in the period 2015-2021 a reduction of a mere 5.9% was achieved.
Similarly, the burden of drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB (RR-TB) in 2021.
This, says WHO, is the first time in many years an increase has been reported in the number of people falling ill with TB and drug-resistant TB.
This “stalling” in progress towards achieving WHO and UN tuberculosis targets is attributed to the disruptions caused by the Covid-19 pandemic in 2021 and ongoing conflicts across Eastern Europe, Africa and the Middle East which exacerbated the situation for vulnerable populations and severely impacted the response to TB through the reallocation of resources away from the “other pandemics” such as TB to containing Covid-19.
The impression may be that fighting the “other pandemics” in tandem with Covid-19 is a zero sum game.
That couldn’t be further from the truth in a world of multiple pathogens and vectors, some still unknown to us.
If climate mitigation targets are not met in the near-to-medium term, as the proceedings and bickering trajectory in Sharm el-Sheikh seem to point to, it can only further impede the progress towards the 2025 WHO End TB Strategy and eradicating such diseases because destructive climate change could result in a perfect storm of creating the ideal climatic conditions for pathogens such as the mycobacterium tuberculosis to thrive in vulnerable communities already stressed by the impacts of the above disruptions.
TB most often affects the lungs.
It is the second-deadliest infectious killer after Covid-19. In 2021, men accounted for 56.5% of the TB burden, women for 32.5% and children for 11%.
Many new cases, says the WHO, are attributable to five risk factors: undernutrition, HIV infection, alcohol use disorders, smoking and diabetes.
All these risk metrics are prevalent in South Africa in addition to economic, financial and social barriers, and stigmas that affect access to health care for TB diagnosis and completion of treatment.
Disturbingly, over half of patients and their households in South Africa face catastrophic total costs due to TB.
The failure to bring the disease under control underlines the perversities and fragility of humanity’s response and inability to contain if not eradicate a disease that various stakeholders persistently tell us is “preventable and curable”.
If we can’t do this for historical pandemics such as TB, malaria and polio, what hope is there of achieving the much-vaunted and complex rubrics of climate action – mitigation, adaptation and finance?
TB, of course, is prevalent in every part of the world. Unfortunately for South Africa, it is a member of a cohort of 30 countries that carry the stigma of being classified by the WHO as the “highest burden countries (HBCs)”.
In fact, 17 of the 30 HBCs are from sub-Saharan Africa. While South Africa has made some progress in its response to TB, there is still much work to be done in various areas.
In 2021, while India, China, Indonesia, Philippines and Myanmar accounted for 90% of the global reduction in case notifications of people newly diagnosed with TB compared with 2019, South Africa did not feature.
The severity of national TB epidemics, in terms of the number of incident TB cases per 100 000 population per year, also shows that in 2021, South Africa is in the higher tensile of 500 cases per 100 000 population.
South Africa is also one of 10 countries with the largest gaps between notifications of new and relapse (incident) TB cases and the best estimates of TB incidence in 2021; and that account for about 70% of the global gap between the estimated global incidence of MDR/RR-TB each year and the number of people enrolled in treatment in 2021.
“Continued challenges with providing and accessing essential TB services,” notes the WHO, “have meant that many people with TB were not diagnosed and treated. The reported number of people newly diagnosed with TB fell from 7.1m in 2019 to 5.8m in 2020. There was a partial recovery to 6.4m in 2021, but this was still well below pre-pandemic levels.
“These reductions suggest that the number of people with undiagnosed and untreated TB has grown, resulting in increased TB deaths, more community transmission of infection and after some lag-time, increased numbers of people developing TB. The number of people provided with treatment for RR-TB and multidrug-resistant TB (MDR-TB) also declined between 2019 and 2020. The reported number of people started on treatment for RR-TB in 2021 was 161 746, only about one in three of those in need.”
On the positive side, South Africa, is also one of seven high TB burden countries that reached or passed the first milestone of a 20% reduction in the TB incidence rate compared with 2015, and collectively accounted for 82% of those started on preventive treatment in 2021.
To their credit, some 79% of TB funding in 2021 was from domestic sources, as in the previous 10 years. But there was a decline in global spending on essential TB services from $6 billion (R103bn) in 2019 to $5.4bn in 2021, which is less than half of the global target of $13bn annually by 2022.
As elsewhere, climate adaptation finance and international donor funding for TB response, while crucial, remains immorally inadequate.
Whether the 2022 World TB Report “urgently redoubles efforts to get the TB response back-on-track to reach TB targets, save lives, and put a stop to this long-time killer”, as Dr Tereza Kasaeva, director of WHO’s Global TB Programme, hopes for, leading up to the second UN High Level Meeting on TB next year, only time will tell!
Parker is an economist and writer based in London
Cape Times