Activists call for SA’s biggest killer to be declared a public health emergency

As world health bodies applauded the country for making progress in fighting the scourge of TB, the figures tell a different story, and, those who have insight into its management, warn not enough is being done by the government to end it.

Last week, during the commemoration of World TB Day, Minister of Health Dr Joe Phahla stood on a podium to assure the nation that the country continued to make strides in the fight against the highly infectious disease, saying: “Unlike many of the diseases that we are battling, TB is preventable and curable. We must take a stance now that ‘Working Together’ we will end TB in our lifetime.”

He urged everyone to join hands and “mark in the sand” the effort to defeat it and ensure that losses due to TB were reversed as 2030, the deadline the UN and member states have set to end TB, HIV, and STIs as public health threats, draws close.

However, those close to the actual work to end TB said these were just words devoid of action.

Advocates, among them the Treatment Action Campaign (TAC) and TB Accountability Consortium, took the day to call the government out for failing in its responsibility to prioritise TB, saying it was not taking enough action to facilitate service deliverables.

They said they were concerned about the lack of progress regarding the roll-out of TB services across the country.

“We are calling on the government to fully capacitate the country’s national TB programme to lead and coordinate the implementation of its national TB strategies and guidelines,” said the advocates.

They said that despite being treatable, TB remained a significant public health threat and killed more than 54 000 people every year. It remains South Africa’s biggest killer.

Children born in South Africa receive the BCG vaccine at birth and the live vaccine is meant to stimulate a baby's immune system to build antibodies to protect against TB.

“While that is well and good, prevention needs to go further than that,” advocate Matlhatsi Mangope said.

Having survived drug-resistant TB and struggled for support in a community that did not understand her illness, she said the government still had a lot to do if it wanted to meet the goal to eradicate TB.

“First of all, health workers need to know how to handle and tackle TB patients. They are not empowered enough – both with knowledge and treatment methods, and I learnt that the hard way.

“Going to a clinic to be told I was gravely ill and being given little hope kills the spirit. My parents lost hope from the onset, and from there it all went downwards,” Mangope said.

“After colleagues took me in and removed me from my own supposed support structure and treated me like a person with a chance, I survived, only to find out that my own family thought I lived with something they could catch if they let me close. And that is the truth for so many,” she added.

The stigma attached to TB makes it almost impossible for people to survive, let alone get better, she said, as not only are you perceived to have HIV, but you are also always seen as highly contagious.

The TB network said the stigma includes the perceived associations of TB with malnutrition and poverty, and as foreign-born and happening to those of a low social class.

“As with HIV, TB is stigmatised in this context because it is linked to other disvalued characteristics, which themselves are also social determinants of health,” the network said.

And in a country with so many living in poverty, the continued rise of informal townships and overcrowded spaces, the fight against TB has only weakened.

TB and HIV advocate Sithembiso Dlamini said there were too many factors stacked against winning the battle in a country that does nothing to provide adequate food, housing and means to ensure balanced diets for thousands.

“Overcrowded and poorly ventilated home and work environments are one thing. Even if those are okay, with public transport, especially taxis, being the main carrier of the bulk of South Africans, the likelihood of escaping contracting TB remains low,” Dlamini said.

All of this makes TB a very humiliating illness that robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered, the TB network said.

Early detection remained key to a successful TB response, the TAC said. “Too many people with TB continue to go undiagnosed as around 58% of people with TB present without any symptoms.”

This, it said, was in addition to a health system in which even those with symptoms are often overlooked by health-care workers.

It said that Covid-19 showed what strong political will was capable of as everyone everywhere was screened for symptoms.

“Why not the same for TB?” the network asked, as an estimated 155 000 people remain undiagnosed with TB, 105 000 of them living with HIV too.

It said it was calling for TB to be declared a priority by the Department of Health and government and for its status as a danger to growth to be elevated.