The World Health Organisation (WHO) is warning that Africa could miss targets to end tuberculosis (TB) unless it can reduce TB deaths by 75 percent and cases by 50 percent by 2025.

To hit this milestone, Africa’s annual pace of TB reduction should reach 10 percent, but this currently stands four percent. Though this twice the global pace, the WHO says this must be pushed to 10 percent per year by 2025 and accelerated to 17 percent by 2030.

The End TB Strategy seeks to realise a world free of the disease by 2035 and for this to happen, countries must cut TB deaths by 90 percent and cases by 80 percent by 2030.

“The question is no longer about whether we can end TB, but how fast we must act to reduce the disease burden, save lives and maintain a high momentum towards a TB-free world,” said WHO Africa Director Matshidiso Moeti, during a press briefing on World Tuberculosis Day on March 24.

TB deaths in the region fell by 26 percent between 2015 and 2021, with high-burden TB countries surpassing initial targets to lower TB cases.

African countries have increased uptake of new WHO-recommended tools and guidance, resulting in early access to TB prevention and care and better outcomes. The proportion of people diagnosed with TB who were initially tested with a rapid diagnostic. For example, it increased from 34 percent in 2020 to 43 percent in 2021.

A poster educating people on preventing the spread of TB. PHOTO | NMG

Infectious killer

TB is preventable and curable, yet 10 million people fall ill annually, making it the world’s most infectious killer.

Major barriers to ending TB include limited access to health services, inadequate health infrastructure, quality of care, human and financial resources for health and social protection.

At least 25 percent of all TB cases are in Africa, and so are 25 percent of deaths.

It is also the leading cause of death for those infected with HIV.

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Africa’s HIV burden causes further complications as those infected are 18 times more likely to develop TB. The conditions form a lethal paradox, each accelerating the development of the other. At least 85 percent of TB patients in Africa are also HIV positive.

According to WHO, under-investment by governments in TB control is a significant drawback to the fight against the disease. For example, of the estimated $3.9 million required for the Africa’s 2018-2021 TB response plan, only $957 million was mobilised each year.

Funding for TB prevention, diagnosis and treatment services globally continues to fall far short of estimated needs and UN target. In 2020, global spending on TB services fell to $5.3 billion and funding for research was $901 million.

Africa still records a significant gap between the estimated number of TB cases and those that are diagnosed. In 2021, the latest year for which data is available, an estimated 40 percent of cases were not reported or diagnosed.

In September, a high-level meeting on TB will be held during the UN General Assembly bringing together heads of state to help ramp up TB control efforts.

“Without robust joint efforts, this preventable and treatable disease will remain a serious public health threat with costly impacts for individuals and societies,” said Dr Moeti.

New TB vaccine

Meanwhile in Kenya, the Kenya Medical Research Institute (Kemri) has announced two promising TB vaccines that if approved will see the TB treatment period reduced from the current 6-18 months to four months.

The tuberculosis vaccine fends off a slew of unrelated infectious diseases and its immune boost can protect newborns for more than a year. PHOTO | AFP

“A BCG recombinant Phase 3 vaccine trial in infants is underway in Nairobi and Siaya Counties where at least 1,500 participants have been recruited for the vaccine that originates from the Serum Institute of India. Additionally, Kemri has been selected by Gates MRI Foundation to conduct M72 Adult TB Vaccine Phase 3 Trial, which will include over 10,000 people in different parts of the world.

“The M72 is a vaccine that helps prevent TB-infected individuals from progressing to active infection. Prior phase 2 clinical trial results indicated the vaccine is promising,” said Kemri.

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Tanzania was selected as one of seven countries that will benefit from a Unitaid-funded programme that will provide 250,000 patient courses of short course rifapentine-based TB preventive treatment regimens that includes a three-month regimen and one for 28 days.

This contribution is part of the IMPAACT4TB Consortium's ongoing efforts to end TB.

“TB prevention is a cornerstone of any effort to eliminate TB and we hope that these 250,000 patient courses will contribute to countries’ efforts to finally make TB a disease of the past,” said Prof Gavin Churchyard, CEO of Aurum Institute and the principal investigator of the IMPAACT4TB project.