The global measures to end the tuberculosis epidemic are showing signs of recovery post-Covid. More cases have been diagnosed and the number of people who died from the disease has gone down.  

Despite this apparent recovery, the World Health Organisation (WHO) says urgent action is needed to end the global TB epidemic by 2030. On Tuesday the WHO launched the global TB report which takes stock of the epidemic and the progress towards its elimination. The report paints a stark picture:  targets for TB treatment, prevention and funding have been missed. 

TB is preventable and curable, but it was the world’s second leading cause of death from an infectious disease in 2022. It spreads through the air when a person who is sick with the disease sneezes, spits or coughs. It often affects the lungs but can occur in other parts of the body.

Globally in 2022, TB caused an estimated 1.3 million deaths. This was down from the estimated 1.4  million in 2020 and 2021. It’s also close to the 2019 estimated figure. Around 10.6 million people around the world fell ill with the disease in 2022.

There are 30 countries – South Africa included – classified by the WHO as having a high TB burden. These countries account for 87% of the world’s estimated incident cases. In South Africa TB is a leading cause of death with around 280,000 cases reported each year.

The WHO says research breakthroughs, such as a new vaccine, are needed to rapidly reduce the number of new cases.

“There are many interventions to control TB,” says Professor Willem Hanekom, Director of the Africa Health Research Institute (AHRI). Hanekom was speaking during a media visit recently hosted at the institute’s research facilities in KwaZulu-Natal. “Vaccines are by far the greatest chance we have in controlling the TB epidemic.” 

TB vaccines 

TB is an ancient disease and there is only one vaccine that’s approved to prevent the disease: the Bacille Calmette-Guérin (BCG), which is more than 100 years old. 

“The BCG is given to babies soon after birth, and virtually every baby in the world gets it. It’s extraordinarily widely used and very effective at preventing TB disease in small babies. And therefore it should be given,” says Hanekom. 

But BCG has one major flaw – it doesn’t effectively prevent disease in adolescents and adults, while these populations spread the bacterium that causes TB. According to the TB report, adults older than 15 years account for 90% of cases. In 2022 55% of people who developed TB were men, 33% were women, 12% were children. 

And this is why, Hanekom says, “we need a vaccine that targets adults and adolescents. The good news is that we’re on the verge.” 

Promising vaccine candidate

Hanekom is one of the lead scientists in the South African leg of a global trial for a TB vaccine known as M72 which has already shown promising results. 

“It’s shown to be safe, and it’s already in early trials shown to work to prevent TB disease in adults and adolescents,” says Hanekom. “In fact, it was 50% effective – which is more than enough to impact the TB epidemic. We don’t need the 80-90% that Covid vaccines afford.” 

The phase three trial for the M72 vaccine will provide definitive assessment of whether the vaccine is effective at preventing TB disease. That phase 3 trial is going to involve 26,000 adolescents and adults in 62 sites including 32 in South Africa. 

“It’s very exciting, it’s starting next year.Preliminary findings are likely to be available in 2028, while the final results will emerge in 6 years,” explains Hanekom. 

Covid recovery 

COVID-19 and its related lockdowns were a major disruption to the global effort to end TB. These have resulted in an estimated half a million excess deaths from TB between 2020 and 2022.  

Professor Kogie Naidoo, deputy director of the centre for the AIDS programme of research in South Africa (CAPRISA), says South Africa’s TB programme is yet to recover from the pandemic. 

“The Covid-19 pandemic definitely affected the fight against TB in South Africa. We saw a sharp drop in the number of TB testing in our laboratories and we also saw a sharp drop in the number of patients presenting for TB services at facilities,” she  says. 

Naidoo says that since the Covid-19 pandemic, the numbers of TB cases have been slowly dropping in South Africa. 

“The number of TB cases are certainly not as high as the pre-pandemic levels. But we’ve seen here [in South Africa] and globally, the increase in TB deaths.” 

South Africa needs to scale up its data reporting on TB – the same way it was done with Covid-19 – in order to keep up with the exact number of TB cases being diagnosed, she says. 

“With Covid-19 we knew how many cases were being diagnosed and how many deaths were Covid-19 related in almost real time. But with TB, there is a lag in our understanding of the epidemic.”

More must be done

Naidoo says that more still needs to be done to stop the spread of TB in South Africa.

“Our fight against TB is not over. The disease remains our number one cause of hospital admission and deaths in South Africa. 

“We need to do more to refer patients that have symptoms to health facilities and to also find their close contacts, and put more people on treatment,” says Naidoo.

Meeting the global targets to end TB needs investments on all fronts. – Health-e News

Reporting by Ina Skosana and Ndivhuwo Mukwevho