Tuberculosis (TB) is a significant public health challenge with 10 million new cases diagnosed annually worldwide and 1.5 million TB-related deaths reported each year.  The disease was first discovered in 1882 by Robert Koch – a feat that earned him a Nobel prize – and remains a significant public health challenge to this day.

To raise public awareness about the disease’s devastating health, social and economic consequences, and to step up efforts to end the global TB epidemic, the World Health Organization marked 24 March as World TB Day. This year’s theme is: “Local actions, global impact” and nothing could be more appropriate for our current situation in South Africa where healthcare workers, policy makers and researchers race to find practical solutions to curb the health crisis posed by tuberculosis. 

The burden of TB, unlike the recent COVID-19 pandemic, falls largely on low-and-middle income countries. If TB had to enjoy the kind of collaboration, funding and global attention that COVID-19 did, I believe we would be much further along in our efforts to end it.

The local landscape

In South Africa, more people die of TB every day than in any day during the COVID-19 pandemic. On the other hand, the country is uniquely positioned with scientists, clinicians, and platforms to not only have a local impact when it comes to managing TB, but to also influence how the disease is managed globally.

South Africa has high rates of both TB incidence and TB-related mortality. This means the country faces challenges such as stigma, infection control, adherence to long treatment regimens, drug-resistant TB and co-infection with HIV, making this a particularly complex disease to manage.

Efforts to combat TB in South Africa are multimodal. They include widespread testing and early diagnosis, evidence-based treatment and care, the promotion of infection control measures, as well as initiatives to address TB-HIV co-infection.

Recent research has highlighted the importance of the basics, such as good nutrition and social support for patients diagnosed with TB. South Africa recently launched new guidelines on TB prevention therapy and shorter regimens of treatment for drug resistant TB.  These developments, particularly the latter, speak well to the theme of local actions having global impact. The multicentre studies guiding the practice of shorter treatment regimens included patients from South Africa and have had global impact on mortality and morbidity.

On the other hand, challenges such as limited resources, healthcare infrastructure constraints, and social determinants of health continue to impact TB control efforts in the country. Addressing these challenges requires sustained investment in healthcare infrastructure, innovative approaches to TB diagnosis and treatment, as well as addressing social determinants of health such as poverty and access to healthcare services.

Research efforts and the way forward

At the University of Pretoria, we have a spectrum of ongoing research to:

• improve our ability to rapidly diagnose TB,
• find a safe vaccine,
• understand transmission,
• elucidate the effects of subclinical TB on public health,
• curb the long-term health effects of TB,
• and investigate the social impact of TB in the communities we serve.

We have a unique Airborne Infection Research (AIR) facility, which allows us to study natural TB transmission using animals. The AIR facility has hosted multi-university collaborations in our efforts to have a significant global impact on the fight against TB.

I consider TB to be the prototype disease for transdisciplinary research.  If our practices at the “coalface” of patient care are not evidence-based, then we do our patients no justice.  However, if our science is not guided by an understanding of what happens in households, of the impact of prolonged periods away from work for breadwinners, an understanding of the stigma that often comes with being diagnosed with TB, then it loses relevance. 

If we are to end TB, as the World Health Organization has tasked us, then it will take a combination of excellent science to improve our ability to rapidly diagnose TB. We’ll need new medications with less side-effects to treat patients more effectively and improve compliance and we’ll have to overcome stigma and disinformation about TB. In addition, we’ll need to engineer efforts to improve the ventilation of the structures that people live and work in, and improve social upliftment efforts and educate South Africans about TB.

Prof Veronica Ueckermann is Head of Infectious diseases at the University of Pretoria’s Department Internal Medicine and at the Steve Biko Academic Hospital.

Disclaimer: The opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the University of Pretoria.