In a con­nected world, tu­ber­cu­lo­sis cases can pose a deadly threat

Khaleej Times - - FOCUS ANALYSIS - IBRAHIM as­sane mayaki Ibrahim As­sane Mayaki, a for­mer prime min­is­ter of Niger, is CEO of the New Part­ner­ship for Africa’s De­vel­op­ment (NEPAD)

The world is fi­nally wak­ing up to the threat posed by one of the most over­looked dis­eases of our time. Last month, the United Na­tions Gen­eral As­sem­bly (UNGA) hosted the first-ever high-level meet­ing on tu­ber­cu­lo­sis (TB) to ex­plore op­tions for in­ter­na­tional erad­i­ca­tion ef­forts. But, as wel­come as this new global fo­cus is, the fact re­mains that the road to beat­ing TB be­gins in Africa.

Sim­ply put, TB re­mains one of the dead­li­est epi­demics in Africa to­day, and one-quar­ter of all TB deaths world­wide oc­cur there. In 2016, some 417,000 peo­ple on the con­ti­nent suc­cumbed to the disease. Re­cent out­breaks of mul­tidrug-re­sis­tant TB and ex­ten­sively drug-re­sis­tant TB in South Africa, Mozam­bique, and Ghana could push the an­nual death toll even higher. These pock­ets of the bac­terium, now com­pletely im­mune to an­timi­cro­bial treat­ment, mean that the chal­lenge of global erad­i­ca­tion has be­come even more daunt­ing.

Part of the rea­son for TB’s per­sis­tence is the vul­ner­a­bil­ity of the pop­u­la­tions it in­fects. For starters, TB is among the lead­ing killers of HIV-pos­i­tive peo­ple, claim­ing some 40 per cent of those who die from HIV. This poses dan­gers for non-HIV pa­tients as well, es­pe­cially those with sup­pressed im­mune sys­tems, young chil­dren, and in­fants.

Erad­i­ca­tion is also dif­fi­cult be­cause TB is a highly con­ta­gious air­borne bac­terium; peo­ple liv­ing and work­ing in close quar­ters — such as min­ers, pris­on­ers, mi­grants, and refugees — suf­fer the high­est rates of in­fec­tion. Fi­nally, be­cause TB preva­lence is closely linked to poverty and so­cial marginal­i­sa­tion, reach­ing those most at risk is not al­ways easy.

In­fec­tious dis­eases have no bor­ders, and as African coun­tries deepen their trade ties and in­tra-Africa mi­gra­tion grows, the threat of re­gional pan­demics will only in­crease. This makes it all the more crit­i­cal that Africa be­gin de­vel­op­ing a mul­ti­sec­tor, in­te­grated ap­proach to con­tain­ing, con­trol­ling, and even­tu­ally erad­i­cat­ing pub­lic-health chal­lenges like TB.

To this end, one ap­proach that African gov­ern­ments could em­u­late is the TB man­age­ment strat­egy in place for the con­ti­nent’s min­ing sec­tor, an in­ter-agency plan de­vised in 2014 by the South­ern African De­vel­op­ment Com­mu­nity. Al­though this so-called “har­monised” ap­proach ap­plies to a com­mer­cial in­dus­try, its fo­cus on co­or­di­nat­ing with the Re­gional Eco­nomic Com­mu­ni­ties (RECs) — African Union states grouped for eco­nomic in­te­gra­tion — could serve as a model for more ef­fec­tive col­lec­tive ac­tion on TB con­tain­ment.

But be­fore a spe­cific frame­work can be agreed upon, three is­sues re­quire ur­gent at­ten­tion. First, African health-care plan­ners and disease spe­cial­ists must set coun­try, re­gional, and lo­cal con­tain­ment tar­gets. For ex­am­ple, set­ting goals for re­duc­tions in new TB in­fec­tions would en­able health of­fi­cials to mea­sure more ac­cu­rately the im­pact of their strate­gies.

More­over, to end TB com­pletely, Africa will need new and sus­tained fi­nan­cial com­mit­ments from the pub­lic and pri­vate sec­tors. And, fi­nally, dis­easec­on­trol strate­gies must be de­signed to sup­port the eco­nomic and health-care pri­or­i­ties of the re­gional eco­nomic com­mu­ni­ties. At the mo­ment, most state and re­gional health-care sys­tems lack fund­ing and hu­man re­sources. African pol­i­cy­mak­ers must there­fore de­velop sys­tems for pre­ven­tion, di­ag­no­sis, and care that help gov­ern­ments share the disease bur­den and en­sure that treat­ment pro­to­cols are con­sis­tent across re­gions.

To be sure, there are some pos­i­tive trends in the fight against TB. Global in­fec­tion rates are fall­ing by about 2 per cent an­nu­ally, and even African coun­tries hit by TB still man­aged a 4 per cent de­cline in in­fec­tions from 2013 to 2017. And, with or­gan­i­sa­tions like the World Health Or­ga­ni­za­tion and the African Union be­gin­ning to pro­duce roadmaps for TB erad­i­ca­tion, it is clear that mo­men­tum is steadily build­ing.

Still, sus­tain­ing this progress in Africa will re­quire sig­nif­i­cant re­gional co­or­di­na­tion, not to men­tion a lot more money. Most vac­cines and med­i­ca­tions are cur­rently too ex­pen­sive for the ma­jor­ity of Africans. But even those lucky enough to ob­tain treat­ment — usu­ally a six- to eight-month course of pow­er­ful an­tibi­otics — still face a 20 per cent chance of re­lapse.

The goal of erad­i­cat­ing TB is within reach; the re­cent gath­er­ing at the UNGA marked a crit­i­cal turn­ing point in the world’s war on the disease. But even as com­mit­ments are made and dec­la­ra­tions signed, we must re­mem­ber that in Africa, the bat­tle is far from over.

Disease-con­trol strate­gies must be de­signed to sup­port the eco­nomic and health-care pri­or­i­ties of the re­gional eco­nomic com­mu­ni­ties. At the mo­ment, most state and re­gional health-care sys­tems lack fund­ing and hu­man re­sources.

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