A plan to escalate the TB fight by boosting the number of people testing for the disease to 5m over the next 12 months – a massive increase from the 2.7m tested in 2023 – is on the cards for SA, while on a broader scale, the WHO is urging global leaders to step up efforts to mitigate the global funding crisis.
Speaking at the launch of the local TB campaign last week, programme head Professor Norbert Ndjeka said scaling up testing would help SA reach the target set in the WHO strategy to end the global TB epidemic by 2035, writes Yoliswa Sobuwa for Health-e News.
“Modelling suggests testing 5m people annually will help achieve a 29% reduction in TB incidence and a 41% reduction in mortality by 2035,” he said.
The WHO targets are:
• 95% reduction by 2035 in TB deaths;
• 90% reduction by 2035 in new TB cases; and
• Zero families facing catastrophic costs due to TB.
Since the start of the End TB strategy in 2015, South Africa has seen a 53% reduction in new TB cases, surpassing the WHO 2025 target of 50%. In the same period, it increased treatment coverage from 58% to 77%, but failed massively to reduce deaths.
The WHO target is 75%, but TB deaths only went down by 16% over the same period.
In 2023, TB claimed 56 000 lives, making it one of the leading causes of death in the country. “This means one in five people die from TB in South Africa every year,” Ndjeka added.
Obstacles to TB response
The country’s fight against TB is faced with social and economic challenges, a key obstacle being the persistent stigma surrounding TB and HIV, often deterring people from seeking timely diagnosis and treatment. Other barriers include a lack of trained healthcare workers, poor referral systems, drug stock-outs and mistrust in the health system.
Ndjeka said limited access to services in rural and remote areas, coupled with inadequate infrastructure and resources, also hinders early detection and proper care.
Health Minister Dr Aaron Motsoaledi said a survey had revealed that 56% of TB patients experience catastrophic costs.
“This is one of the reasons why we lose many people in treatment,” he said.
Professor Nazir Ismail from the WHO’s global TB programme said that 58 000 people with TB are undiagnosed and untreated – a slight decline from 66 000 in 2022 – contributing to the ongoing transmission of TB.
“For every diagnosed case of TB, there is another person who is missing,” he added.
Males contribute a larger proportion of TB cases but are less likely to access treatment.
Ismail said fighting TB required multi-sectoral engagement and closer collaboration with communities to tackle demand and supply side factors and to find and successfully treat patients.
Worldwide disruptions
On World TB Day on Monday, the WHO called for an urgent investment of resources to protect and maintain care and support services for people in need across regions and countries.
Although global efforts to combat infections have saved an estimated 79m lives since 2000, the recent abrupt cuts in global health funding are threatening to reverse these gains, the agency said.
Under the theme Yes! We Can End TB: Commit, Invest, Deliver, the World TB Day 2025 campaign is a rallying cry for urgency, and accountability and hope, said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“But we cannot give up on the concrete commitments made by world leaders at the UN General Assembly just 18 months ago to accelerate work to end TB. WHO is committed to working with all donors, partners and affected countries to mitigate the impact of funding cuts and find innovative solutions,” he said.
Funding threat to global efforts
Early reports to WHO reveal that severe disruptions in the TB response are already being seen across several of the highest-burden countries.
The WHO African region is experiencing the greatest impact, followed by countries in the WHO South-East Asian and Western Pacific regions: 27 countries are facing crippling breakdowns in their TB response, with devastating consequences, while nine countries report failing drug procurement and supply chains, jeopardising treatment continuity and patient outcomes.
The funding cuts further exacerbate an already existing underfunding for global TB response, said the WHO.
In 2023, only 26% of the $22bn annually needed for TB prevention and care was available, leaving a massive shortfall.
TB research is in crisis, receiving just one-fifth of the $5bn annual target in 2022, severely delaying advancements in diagnostics, treatments, and vaccines, added the agency.
WHO is leading efforts to accelerate TB vaccine development through the TB Vaccine Accelerator Council, but progress remains at risk without urgent financial commitments.
Joint statement with civil society
In response to the urgent challenges threatening TB services worldwide, WHO’s Director-General and Civil Society Task Force on TB issued a joint statement this week demanding immediate, co-ordinated efforts from governments, global health leaders, donors, and policymakers to prevent further disruptions. The statement outlines five critical priorities:
- Addressing TB service disruptions urgently, ensuring responses match the crisis’ scale;
- Securing sustainable domestic funding, guaranteeing uninterrupted and equitable access to TB prevention and care'
- Safeguarding essential TB services, including access to life-saving drugs, diagnostics, treatment and social protections, with cross-sector collaboration;
- Establishing or revitalising national collaboration platforms, fostering alliances among civil society, NGOs, donors, and professional societies; and
- Enhancing monitoring and early warning systems to assess real-time impact and detect disruptions early.
WHO is also driving the integration of TB and lung health within primary healthcare as a sustainable solution, and promoting better use of existing health systems, addressing shared risk factors like overcrowding, tobacco, under-nutrition and environmental pollutants.
Health-e News article – Why It’s Difficult To Reduce TB Deaths (Creative Commons Licence)
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