Aid Organisations Need to Step Up in Fight Against TB

United States (US) President Trump’s spending freeze on foreign aid marks a significant challenge for the international development community, and many experts warn that diseases will surge.

During this time of uncertainty about the future role of the world’s biggest donor, the Global Fund stands as a beacon of hope.

Since the beginning of the millennium, the Geneva-based multilateral organisation has been fighting one of humanity’s oldest scourges, infectious disease – and specifically the three big killers, malaria, HIV, and tuberculosis (TB).

Through targeted funding and innovative strategies, the Global Fund has made significant breakthroughs against malaria and HIV.
Now the time is ripe to sharpen its focus on TB. 

TIME TO REASSESS

Nearly one-third of the Global Fund’s 2023-2025 allocations, some US$4.17 billion (around N$76.4 billion), has gone towards fighting malaria.

Countries like Rwanda and Zambia have seen remarkable declines in malaria cases and deaths.

For HIV, the fund is spending US$6.48 billion (around N$118.8 billion), which is nearly half its allocations.

In the past decade, the fund has facilitated access to antiretroviral therapy for millions, helping to transform HIV from a fatal disease into a manageable chronic condition.

Together, these efforts have saved countless lives and advanced global health security.

But it is now time to reassess. TB prevention and control has been allocated US$2.4 billion (around N$4.3 billion), or just 18% of the Global Fund allocations budget – and has received less than HIV or malaria every year since the Global Fund was created.

But TB now kills more people than HIV and malaria together.
It is by far the world’s leading infectious disease killer.

Not only do malaria and HIV receive far more resources than TB, but they also get much more global publicity and media coverage.

TB, in comparison, is a neglected, forgotten, and often ignored disease.

To understand why, we need to look at the history of TB.

A TSUNAMI OF DEATH

For people in the rich world today, the disease is little more than a dim memory of a bygone era. But back then, TB was frightful.

In the 1800s it brought a tsunami of death, killing one-in-four across Europe and the US.

For most of the 1800s, New York City’s TB death rate alone was higher than the total death rate in the city today.

Across the 1800s, TB was a much bigger killer than the recent global Covid pandemic managed even in its worst year.

Over the past two centuries, TB has likely killed one billion people.

Yet, almost like magic, TB has disappeared in the rich world.

Antibiotics and a childhood vaccine, combined with better living standards, rudimentary public health measures, and subsequent treatment breakthroughs, mean the disease has been largely eradicated in wealthier countries.

But mostly, TB has lost the attention of the rich world.

Not so for the world’s poorer half, where tuberculosis still claims nearly 1.3 million lives every year – that is greater than the combined death toll of HIV-AIDS (630 000) and malaria (619 000).

POVERTY

For more than half a century, we have known how to cure TB.

Yet, it persists and kills a record number of people in poorer parts of the world. It mostly kills adults in their prime, leaving children without parents.

TB has become an illness of poverty.

It spreads when people live in close quarters and are unable to afford space, and it thrives among populations who cannot afford basic healthcare and services.

The most vulnerable, living in slums, migrant areas, mining towns and prisons are also the most voiceless.

TB has gone from risking the lives of all to just killing those nobody cares enough about.

This shouldn’t be the way. We know how to defeat the disease. It would take surprisingly few resources.

Research for the Copenhagen Consensus think-tank shows that additional expenditure of US$6.2 billion (around N$113.6 billion) annually could save about a million lives a year over coming decades, making this one of the very best possible development policies.

This spending would enable much broader diagnosis to end onward infections and ensure most TB patients stay on medication, reducing deaths by 90% by 2030.

The benefits, including a reduction in death and disease, outweigh the healthcare and time costs by 46 to one.

BEST OPTIONS

The Global Fund is in the middle of its three-year replenishment cycle, when it asks the world for more resources.

The world needs to be generous because the Global Fund has shown it is one of the very best ways to achieve good in the world.

The Global Fund – as well as development agencies everywhere – need to focus more on the illness that is claiming the most lives, and where investment can deliver an astonishing return on investment.
 

• – Aaron Motsoaledi is South Africa’s minister of health. Bjorn Lomborg is president of the Copenhagen Consensus.