The tuberculosis (TB) epidemic remains among the deadliest and most persistent threats to global health, claiming more than one million lives annually. The urgent need to “End Tuberculosis”, is encapsulated in the United Nations’ Sustainable Development Goal (SDGs), which commits to eradicating the interconnected epidemics AIDS, TB, malaria and other communicable diseases by the year 2030. 

Despite notable improvements and achievements in TB treatment coverage, awareness campaigns and research and development, South Africa maintains one of the highest incidence rates of TB in the world, with an estimated prevalence of 852 cases per 100 000 population, as confirmed by the 2022 national tuberculosis prevalence survey

Vulnerable groups

The tragedy of disease lies in its indiscriminatory nature, manifesting without prejudice or bias, often indifferent to socio-economic standing and other demographics. However, with TB, research outcomes repeatedly indicate that the populations groups most at risk of infection are those among the poorest and most vulnerable strata of society, often already contending with comorbidities such as hypertension, diabetes and HIV/AIDS. 

Compounding the issue is the fact that South Africa remains the global epicentre of the AIDS epidemic, with an estimated 20% of population living with HIV. The co-epidemic of HIV and TB combine to form a potent cocktail, and a formidable public health challenge. It’s a challenge that demands an integrated, comprehensive and multi-stakeholder intervention. 

Glimmers of hope

In August this year, the Pretoria High Court ruled in favour of the South African Pharmacy Council (SAPC) and its Pharmacy-Initiated Management of the Anti-Retroviral Treatment (Pimart) programme, which will allow specially trained pharmacists to prescribe and manage HIV and TB treatment for patients. The judgement, which was welcomed by public health advocates, was underpinned by courts’ acknowledgment of the need to grow the number of alternative points of health service delivery and, importantly, widen access to antiretrovirals and TB Preventive Treatment (TPT) therapy in the country. 

Vaccination has been a cornerstone of public health for centuries, successfully eradicating or reducing the impact of many deadly diseases, most recently evidenced by the COVID-19 pandemic response. As such, the development of a highly effective TB vaccine holds immense potential, and would represent a milestone for modern medicine, evolving TB from being a curable to preventable disease. 

For these reasons, the findings published by a pioneering collaborative research project between the Walter Sisulu and North West universities on the breakthrough in the development of tuberculosis vaccine has been widely lauded. Following successful immunogenicity studies in two animal models, the next step is to start with human trials, in consultation with the South African Health Products Regulatory Authority (SAHPRA). Yet another testament to the transformative effects that innovative medicines can have. 

Galvanizing minds and resources

For the 2030 goal of ending TB to become a reality, demands a concerted global effort. International forums such as the upcoming 2nd UN High-Level Meeting on TB to be convened 22 September 2023 on the theme of “Advancing science, finance and innovation, and their benefits, to urgently end the global tuberculosis epidemic, in particular, by ensuring equitable access to prevention, testing, treatment and care”, are critical. 

Meaningful funding increases, and pledges for vaccine research and development efforts, along with a greater commitment to strategic partnerships between governments, private sector organisations, civil society groups, and academia remain a priority for TB advocates. 

South Africa, given its high TB prevalence, and association with leading international companies dedicated to researching and developing novel medications, is well positioned to lead the way in revitalising the fight against tuberculosis.