By Sharon Atieno

Though the African region is making progress in reducing tuberculosis (TB) cases, it risks missing major milestones and targets to end the disease if efforts are not scaled up rapidly.

This is according to the World Health Organization (WHO).

The WHO’s End TB Strategy calls for countries to reduce TB deaths by 75% and cases by 50% by 2025 compared with the 2015 levels.

To cross the 2025 milestone, the annual pace of reduction should reach 10% per year. Currently, Africa’s rate of decline is at 4%.

TB deaths in the region fell by 26% between 2015 and 2021, with high burden TB countries surpassing initial targets to lower TB cases.

The World TB Day celebrated on 24th March was marked under the theme “Yes, we can end TB” to spur national action to bolster TB prevention and control.

“African countries have made remarkable progress against TB. The question is no longer about whether we can end TB, but how fast we must act to reduce the disease burden, save lives and maintain a high momentum towards a TB-free world,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

The End TB Strategy also sets 2030 targets to cut TB deaths by 90% and cases by 80% for which the annual reduction progress must be accelerated to 17%, and further reductions to realize the 2035 vision of a world free of TB.

WHO reports that African countries have increased the uptake of new recommended tools and guidance, resulting in early access to TB prevention and care and better outcomes.

The proportion of people diagnosed with TB who were initially tested with a rapid diagnostic, for example, increased from 34% in 2020 to 43% in 2021.

However, major barriers to ending TB persist, WHO says, noting that these include limited access to health services, inadequate health infrastructure, insufficient quality of care, inadequate human and financial resources for health and inadequate social protection.

Underinvestment by governments in TB control programmes is a significant drawback to the fight against the disease. For instance, of the estimated US$ 3.9 million required for the African region’s 2018–2021 TB response plan, only US$ 957 million were mobilized each year for prevention, diagnosis and treatment of the disease.

Africa still records a significant gap between the estimated number of TB cases and those that are diagnosed.

In 2021, the latest year for which data is available, an estimated 40% of cases were not reported or diagnosed. The region also accounts for 23% of the estimated global TB burden and over 33% of global TB deaths.

“TB control efforts require concerted action by all: communities, governments, the private sector and international partners. Our region still suffers unacceptably high TB toll. Without robust joint efforts, this preventable and treatable disease will remain a serious public health threat with costly impacts for individuals and societies,” Dr Moeti said.

New tools and investments

“With the world regaining strength as the COVID-19 pandemic wanes, ending TB as a global health threat is a critically important goal,” said Dr. Lucica Ditiu, the Stop TB Partnership executive director said during the organization’s Board meeting to mark World TB Day.

“We have new innovations now to help us save lives—new diagnostic tools, shorter, less toxic treatment regimens, and new digital tools—and when we add the political muscle that the UN High Level Meeting (UNHLM) will gather to the many dedicated health care professionals already in the front lines, ending TB looks increasingly possible.”

In the past few years, new tools to combat TB have cleared regulatory approvals and entered the marketplace.

These innovations include: rapid molecular tests that can identify TB and resistance patterns in the bacteria; shorter treatment regiments, for drug-sensitive and drug-resistant infections; new digital tools, such as AI enabled ultraportable X-ray systems for screening for TB; and vaccine candidates that have advanced to phase three clinical trials.

In September, a high-level meeting on TB will be held during the UN General Assembly bringing together heads of state to help ramp up action and accelerate TB control efforts.

With investments in TB research and development rising globally to surpass US$1 billion for the first time ever, advocates are looking forward to boost this momentum during this meeting.

They will also push governments and funding institutions to reach the US$2 billion goal pledged at the first UNHLM, and further increase to US$5 billion per annum as estimated by the Global Plan to End TB.

“What we need is quite simple, given that TB kills 1.6 million people every year,” added Dr Ditiu.

“We need increased political commitments from all high TB burden countries, and significantly more financing so that we can meet all the challenges and embark upon a much faster path to new vaccines. We know what it takes to end TB; we need to roll up our sleeves and make it happen.”