Every three minutes, a child dies of tuberculosis (TB), even though treatment is available. In children,under-diagnosis is a major obstacle to effective treatment. TB is the world’s number one infectious disease killer that claimed 1.25 million lives last year which experts stress was preventable. South Africa is a high burden TB country, says the writer
Image: Stuart Tibaweswa
Mushtak Parker
WHEN established and some of the wealthiest democracies start to callously weaponise funding for medical research, vaccination programmes and healthcare aid to developing nations as a tool of a highly ideologised but reckless foreign policy, the only winners are the billions of pathogens gorging themselves in an orgy of potential outbreaks, epidemics and pandemics.
You don’t need a degree in virology or microbiology to understand the devastating socio-health consequences of blocking funding and resources thus disrupting established and efficacious vaccination programmes against tuberculosis (TB), polio, HIV/Aids, measles and so on in some of the poorest countries.
In South Africa for instance, one of the most targeted countries, some 900,000 HIV patients are potentially affected by the abrupt and chaotic decision to axe funding for the US government’s HIV programme, known as the US President's Emergency Plan for Aids Relief (Pepfar), launched in 2003 by then US President George W Bush, and distributed through Washington’s main overseas aid agency USAID, itself in danger of being abolished or subject to massive budget cuts, thus obfuscating its delivery of ground-breaking schemes such as Pepfar that has enabled access of some of the world's poorest people to life-saving anti-retroviral drugs (ARVs) and has saved more than 25 million lives worldwide.
South Africa is one of the biggest beneficiaries of Pepfar, which contributes about 17% to its HIV/Aids programme, in which about 5.5 million people out of eight million living with HIV receive ARVs. Yet, almost five years since the onset of the ‘once-in-a-century’ Covid-19 pandemic, which claimed in excess of 7.09 million lives, the world has regressed in its pathogen prevention programme strategy.
As if natural causes, the multiple mutations of the wily bugs, anti-microbial drug resistance, and the self-defeating narcissistic disrespect our species has shown to nature are not enough, we now have a democratically-elected US president Donald Trump emerging as a wanton disruptor of established medical aid conventions by withdrawing American membership of and support for the World Health Organisation (WHO) and stooping so low by weaponising medical aid as a foreign policy coercive tool – simply because he thinks he has the power to do so.
The official reason is to cut government expenditure. The real reason is to punish countries such as South Africa for its support of the Palestinians and daring the International Court of Justice to investigate Israeli strongman Benjamin Netanyahu (together with since then assassinated Hamas operatives) on allegations of genocide and issuing a warrant against Netanyahu for war crimes.
Successive US governments irrespective of political colour have been staunch supporters, funders and providers of state-of-the-art weapons of mass destruction to Israel.
How ironic if not surprising that on this day, March 24, as the world is marking World Tuberculosis (TB) Day, the desperate clarion call from WHO in Geneva is that “severe resource shortages are threatening the global response to end tuberculosis (TB)” and that we may be sleepwalking into a global TB crisis.
Since coming to power on January 20, the Trump administration and his coterie of ‘Stepford-style’ sycophants have shown two fingers to two of the most contentious yet consequential policy changes that have global implications.
Trump’s scant disregard for the Paris Climate Agreement and its Net Zero targets as a containment of global warming, from which he has withdrawn US compliance to its goals, and revoking a ban on fracking, new exploration and drilling of oil and gas resources to the puerile ‘war cry’ of “drill baby drill”, is merely the one side of the same disruptor coin. The other side of course is his catchall policy on healthcare, medical aid and vaccination, run and supported by a beauty parade of vaccine sceptics and deniers, and snake oil merchants and private medicine purveyors, in which even Americans themselves are held hostages to fortune.
In Texas and across the US, cases of very contagious measles have risen over the last few months resulting in fatalities especially among the unvaccinated. In charge of the response to the outbreak is Health Secretary Robert F Kennedy, Jr a well-known vaccine sceptic if not denier, whose focus continues to be more on unproven treatments like cod liver oil and other Vitamin A supplements.
Politicians including South African Health Minister Dr Aaron Motsoaledi have called the US unilateral action as “a wake-up call.” The reality is that we have been in similar resource deficient positions before, especially during the peak of the Covid-19 pandemic when governments criminally diverted resources away from their established TB, Malaria, HIV and other programmes, in their fight to contain the pandemic.
In fact, the perennial call for resources for a multitude of campaigns and programmes against various cohorts of pathogens, suggests that the WHO urgently needs a revised if not new funding structure that has financing sustainability embedded and which brings together government, multilaterals, the private sector, Big Pharma, philanthropy, Civil Society and informed lay people. But above all it must have an in-built defence against any government usurping resources for political reasons.
The basis of such a funding structure could be a global mort main or a waqf (endowment trust) which could attract billions of seed funding and thereafter perpetual contributions from the above cohorts through various mechanisms but subject to rigorous oversights in trusteeships, senior management, independent audits et al, but bereft of political influence and intrigue. This could play a major role in reducing or eliminating dependency on donor aid.
TB is the world’s number one infectious disease killer that claimed 1.25 million lives last year which experts stress was preventable. South Africa is a high burden TB country.
According to Deputy President Paul Mashatile: “South Africa remains amongst countries hardest hit by TB, which has remained the leading cause of death claiming an estimated 56 000 lives a year, more than half (54%) of which are people living with HIV.”
Mashatile in fact will launch the government’s National End TB campaign designed to substantially reduce TB incidence and mortality in South Africa by 2035. The campaign will be implemented in phases, starting with a focus on Case Finding and Linkage to care in 2025/26. The campaign also aims to diagnose 250,000 new TB cases in 2025/26 through targeted testing of 5 million people. This will be achieved by implementing Accelerated Targeted Universal TB Testing (TUTT) to reach people living with HIV and household contacts of confirmed TB cases. To what extent Trump’s stay on funding for entities such as Anova Health Institute will impact this latest campaign is not clear.
Dr Tereza Kasaeva, Director of WHO’s Global Programme on TB and Lung Health is sanguine about the impact of a sustained TB resource deficit: “This urgent call is timely and underscores the necessity of swift, decisive action to sustain global TB progress and prevent setbacks that could cost lives. Investing in ending TB is not only a moral imperative but also an economic necessity - every dollar spent on prevention and treatment yields an estimated US$43 in economic returns.”
As one of the solutions to combating growing resource constraints, WHO is driving the integration of TB and lung health in primary healthcare as a sustainable solution.
The 2025 funding cuts, says WHO, further exacerbate an already existing underfunding for global TB response. In 2023, only 26% of the US$22bn annually needed for TB prevention and care was available, leaving a massive shortfall. TB research is in crisis, receiving just one-fifth of the US$5bn annual target in 2022 - severely delaying advancements in diagnostics, treatments, and vaccines. WHO is leading efforts to accelerate TB vaccine development through the TB Vaccine Accelerator Council, but progress remains at risk without urgent financial commitments.
Whether the theme for World TB Day 2025 - ‘Yes! We Can End TB: Commit, Invest, Deliver,’- has the desired effect only time will tell. Global efforts to combat TB led by WHO have saved an estimated 79 million lives since 2000 – a proven and impressive cause that deserves to be over-funded!
Parker is a writer based in London