Even without donor support, South Africa has the means to eliminate tuberculosis

The theme for World TB Day (24 March) – increasing commitment, increasing investment and strengthening delivery of services – is highly appropriate in the era of a new world order and what some have called the end of the golden age of global health consequent to the foreign aid policy changes by the Donald Trump administration.

How should we respond to this crisis in global health as well as the crisis in investment in TB research, development and service delivery? On the basis of global health solidarity, we can make a case for continued donor funding, or we can rethink the commitment and investment by governments of countries with high TB burdens to invest more in TB research and service provision.

Even without donor support, South Africa has the means to eliminate TB. The government provides significant amounts of funding for diagnosing and treating TB. It provides state-of-the-art laboratory services as well as drugs and has well-qualified health workers to diagnose and treat the disease.

However, we know that TB is a social disease – people with poor nutrition and those living and working in overcrowded spaces, for example, are more likely to contract TB. This implies that a whole-of-government approach is needed to eliminate it.

A good place to start is to review where the world and South Africa stand in the fight against TB. According to the 2024 WHO report, 10.8 million people globally fell ill with TB in 2023, with an incidence rate of 134/100,000. In addition, there were 1.25 million deaths attributable to TB (1.09 million of whom were HIV-negative and 161,000 who were co-infected with HIV).

What does the South Africa data tell us? Like many parts of the world, the risk factors for TB in the country are being HIV-positive (and not on treatment), smoking, substance abuse, diabetes and poor nutrition. HIV is the most important risk factor in the country – with a co-infection rate of about 50%.

According to the World Health Organization’s 2024 World TB Report, 270,000 South Africans were diagnosed with TB in 2023, with an incidence rate of 427/100,000. This puts South Africa in the company of the highest-burden TB countries in the world, with people between 24 and 44 more likely to have TB than other age groups, and with men in this age group more likely to have it. We can do much better than this!

We know that many people with TB are not diagnosed and not on treatment. It is estimated that 50% of people with TB do not have symptoms and therefore do not present to clinics. Because they are not diagnosed and treated, they spread TB (unknowingly) to others. Others with symptoms delay seeking care in the hope that their symptoms – like cough, chest pains, night sweats, feeling tired, loss of appetite and loss of weight – will disappear.

Read more: Trump ends SA’s HIV and TB research grants, endangering lifesaving, world class work

As many have said repeatedly, TB is treatable and curable. We have the means to diagnose and treat the disease successfully. The treatment success rate is reported to be 71%, those with drug-resistant TB have a treatment success rate of 62% – but those with TB and HIV have a lower treatment success rate of 51%.

This means we need to do better to ensure that people with TB and on treatment take their medication as prescribed by healthcare workers. TB drugs are like any other antibiotic – a person must complete the course and NOT stop when they start feeling well, which is usually two months after starting on medication, as treatment is currently at least six months.

Many researchers are working on a range of diagnostics, therapies and vaccines to prevent, diagnose and treat TB. A number of vaccines are being researched in South Africa, including the M72 vaccine, with the earliest date at which we will know if they work around 2027/8. While we wait for a vaccine, there is a pill one can take to prevent TB, and all people vulnerable to TB – such as those with HIV – should take this pill. It is free in public clinics.

As said earlier, we also need to diagnose people (with and without TB) earlier and start them on treatment. This is good for the person’s health and will contribute to reducing the chances of transmitting the bacteria to others.

Researchers are working on swabs which can take a sample (in addition to using sputum) and developing testing instruments that can provide a diagnosis while people wait in clinics – which will mean they can get their results and start treatment on the same day.

Also, researchers are working on developing new TB drugs that can cure a person within two months – this means taking TB medication for two rather than six months. We hope to get many of these new innovations within the next few years. In the meantime, we need to use the technology that we have – which works as well.

Read more: We can finally see hope on the horizon for beating TB, the world’s deadliest disease

So, what do we need to do as South Africans to eliminate TB from our country? Sure, we need to improve the social and economic conditions of people, but we also need to seek care as soon as we have TB symptoms.

For those with no symptoms, we need to advise them to seek a test for TB if they are HIV positive, if they are in contact with someone who has TB and if they have had TB in the past (even after being treated one can get reinfected or the bacteria can become active again).

We need to work together like we did during Covid-19 to help each other and the country to eliminate TB in our lifetime. DM

Professor Yogan Pillay is the director for HIV and TB delivery at the Bill & Melinda Gates Foundation. He was previously the country director of the Clinton Health Access Initiative in South Africa and senior director for universal health coverage. In 2021, he was appointed extraordinary professor in the Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University.

Foster Mohale is the Department of Health spokesperson.