Covid plays havoc with End TB Strategy Targets
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CAPE TOWN - One of the unintended consequences of the global Covid-19 pandemic is that it has created havoc with almost every target set in the preceding years by governments, international organisations, rating agencies and corporates.
This has resulted in a target and forecast volatility, which deserves to be classified in a new risk category of its own.
The temptation is to blame the pandemic when in reality most of the structural deficits and deficiencies persisted before the onset of Covid-19.
The pandemic merely exposed these debilities and exacerbated the situation through a scramble for misplaced resource re-allocation.
Nowhere was this more prescient than in health care aided and abetted by a lack of political leadership, poor governance, and a chronic dearth of resources at the national and global levels.
The World Health Organization (WHO), the gatekeeper against global health threats and the champion against Covid-19 vaccine nationalism, inequality and insecurity, for instance, has missed so many of its targets in several health metrics in the past year!
The WHO 2021 Global Tuberculosis Report (GTR) published a few days ago is even more depressing.
All the 13 targets set by the WHO End TB Strategy and the treatment, prevention and funding targets set by the UN High-Level Meeting on TB have failed to materialise.
To many these may be mere statistics and semantics. But to the 5.8 million people newly diagnosed with TB and the loved ones of those 1.5 million people who in 2020 succumbed to the disease, which is the second leading infectious killer after Covid-19, it is a matter of life and death and of livelihoods.
The 5.8 million figure for 2020 is down on the 7.1 million in 2019. But WHO estimates that some 4.1 million people missed out on access to care or have not officially reported to national authorities, which pushes the real figure to 9.9 million in 2020.
The WHO End TB Strategy, for instance, has a TB incidence rate reduction target of 20% for 2015 to 2020.
The actual reduction rate was 11%. South Africa to its credit did achieve the 20% reduction rate.
Similarly, the reduction target for the number of TB deaths for the period was 35%, but the actual figure achieved was only 9.2%. The target for the percentage of people with TB facing catastrophic costs was 0% in 2020.
Once again, the actual figure was 47%.
At the same time, 19.8 million people were treated for TB in the period 2018-2020, around half the way towards the five-year target (2018-22) of 40 million.
Some 8.7 million people started TB preventive treatment in the period, about 29% of the way towards the five-year target of 30 million.
Dr Tereza Kasaeva, director of the WHO Global TB Programme, laments that “we stand at a crossroads. We have just one year left to reach the historic 2022 TB targets committed to by heads of state and government at the first UN high-level meeting on TB in 2018, yet the Covid-19 pandemic has reversed gains and set back the fight against TB by several years.”
For South Africans, TB is a clear and present danger. It is classified as a High TB Burden Country and one of eight countries together with India, China, Indonesia, Philippines, Pakistan, Nigeria, and Bangladesh that accounted for two-thirds of the global total of 9.9 million that fell ill with TB in 2020.
Albeit South Africa’s 3.3% contribution pales that of India at 26% and China’s 8.5%.
Nevertheless, WHO estimates show that the country’s TB Burden in 2020 alone totalled 328 000 people, of which 234 000 were people who were also HIV-positive, the highest in the world. Of this 61 000 people died of the disease.
Age and gender differentiation shows that the age group most affected by TB in South Africa are between 25 and 44, with men outnumbering women by almost 20%.
Disconcertingly, TB treatment coverage was only 58% in 2020, most likely exacerbated by the lockdowns related to Covid-19. New and relapse TB notifications amounted to 191 074.
Laboratory-confirmed cases of multidrug-resistant TB or rifampicin-resistant TB (MDR/RR-TB) totalled 6 784 cases in South Africa in 2020.
The five risk factors for TB in the country, however, reveal metrics of health and behavioural dysfunction – HIV, undernourishment, alcohol abuse, smoking and diabetes.
As Dr Tedros Ghebreyesus, Director-General of WHO, reminded: “The struggle to end TB is not just a struggle against a single disease. It’s also the struggle to end poverty, inequity, unsafe housing, discrimination and stigma, and to extend social protection and universal health coverage.”
To its credit, Pretoria, like other BRICS countries, has funded its TB programme primarily from domestic sources.
The 2020 TB Budget comprised about $150 million (about R2.2m) from the Health Department, compared with $30m from international sources. According to WHO, the $225m 2021 TB Budget comprises 72% from domestic sources and 28% from international sources.
As preparations begin for the Second UN high-level meeting on TB in 2023, Dr Kasaeva’s clarion call is for “redoubling efforts and investments to urgently close widening gaps in access to much-needed prevention and care for the millions affected by this ancient but preventable and curable disease.”
TB response remains critically underfunded with committed funding for TB prevention, care and R&D falling far short.
Some $13 billion annually is required for TB diagnosis and care by 2022. For R&D, at least an extra $1.1bn per year is needed to accelerate the development of new tools.
There is a need for increased investments from domestic and international sources because the diagnostic pipeline remains robust in terms of the number of tests, products, or methods in development; 14 vaccine candidates and 25 drugs and several combination treatment regimens are in clinical trials.
The rewards are literally life-changing, for TB treatment saved 66 million lives globally between 2000 and 2020!
* Parker is an economist and writer based in London