By Dr Allan Pamba, Executive Vice President, Diagnostics, Africa at Roche Diagnostics
OVER many centuries, tuberculosis (TB) has travelled alongside humanity.
Mycobacterium tuberculosis (MTB) is thought to have been around for millions of years and has had many names. In ancient Greece, it was called “phthisis”; in the 1700s, the “White Plague” and in the 1800s, it was graphically referred to as the “consumption”.
Until relatively recently, TB was considered incurable – a deadly companion that caused 25% of all European deaths between the 1600s and 1800s alone. In 1921, however, the first vaccine was developed, and by the mid-20th century, Antibiotics had gained us the advantage.
Presently, we can identify, diagnose and treat TB – and even latent TB – to prevent the disease from developing. One might think these scientific breakthroughs would finally allow us to bid a not-so-fond farewell to this unwanted sidekick that had long outstayed its welcome. Unfortunately, TB has proven to be more persistent than we had hoped – and today, it is still one of the most significant health challenges facing Africa.
An estimated 2.5 million people fell ill with TB in the African region in 2021, and around 500,000 people died of the disease in the same year. This was compounded by the impact of COVID-19 on health systems. Africa accounts for 23% of new cases globally and 31% of TB-related deaths, according to a World Health Organization (WHO) 2023 update.
TB is also a leading killer of HIV-positive people. So, with a vaccine and treatment available, why are so many Africans still dying from this disease?
Conquering TB—as with any other health crisis—requires a complex framework and buy-in from multiple stakeholder groups. Ending TB is a project that starts from the ground up. It begins at the community level and cascades all the way up to national governments. The potential trump card is cooperation from the private sector, which provides opportunities to leverage capacity, innovation and novel funding models.
If your entire hand is injured, bandaging one finger will not fix the problem. Similarly, if patients aren’t aware of their TB status, there is no path to treatment – even when the treatment is available.
There is a large gap between the estimated number of TB cases and the number of notified cases. So, we only see the tip of the iceberg. Additionally, missed diagnosis of drug-resistant TB cases is even more worrying; and one of the primary challenges Africa faces is identifying TB cases among children. Making quality laboratory diagnostics more accessible to people, no matter where they live, is essential.
According to recent estimates (WHO 2023), 47% of the global population has little to no access to diagnostics. Only 30% of health facilities in Africa have the necessary equipment and reagents to perform basic diagnostic tests due primarily to a lack of national prioritisation, which ultimately leads to inadequate resourcing.
Poor, rural communities are the most vulnerable and underrepresented in national healthcare systems. The unfortunate reality these people face is almost as old as the TB bacteria itself.
Even today, history continues to favour the wealthy as TB continues to show a strong association with poverty.
The adoption of the WHO Resolution on Strengthening Diagnostics Capacity by participating member states at the World Health Assembly last year suggests a holistic framework to deliver [quote] “essential healthcare based on practical, scientifically sound and socially acceptable methods and technology […] at a cost that the community and country can afford.”
The 2023 WHO report on TB also notes: “A quality-assured laboratory network equipped with rapid diagnostics is a prerequisite for any national TB programme moving towards the End TB Strategy call for early diagnosis of tuberculosis.”
This is a call to action for African public health providers to find novel ways to provide equitable access to safe, effective, quality-assured diagnostics by holistically re-examining every stage of the healthcare value chain.
The WHO resolution and guidelines are a good start. But how do we change a precedent set hundreds, even thousands of years ago, for poor populations in Africa?
Delivery of universal healthcare requires innovation in funding models as well as solutions. With many competing priorities, governments simply cannot conjure up billions in additional investment.
What they can do though is better stewardship of existing resources to deliver more healthcare.
Facing deficits in the equipment and reagents needed to perform basic diagnostic tests, healthcare facilities may be less accurate in delivering treatment – often treating late and spending more on treatment than would be necessary with early diagnosis.
A strategic redistribution of existing health budgets between diagnosis and treatment could significantly change the healthcare playing field. And with government stewardship, private sector capacity and innovation can be leveraged in win-win partnership frameworks.
Today, platforms and instruments have been established for HIV viral load testing across most of Africa. These platforms were implemented vertically to contain and reverse the AIDS epidemic.
Practically, in the care facilities, HIV patients who require additional tests – for TB, HPV, hepatitis and other critical disease areas – would generally incur extra costs and time, as these additional tests are often analysed on parallel systems and platforms. A little known fact, however, is that these already installed HIV viral load testing platforms can also run all of the above additional tests using integrated testing approaches.
The WHO strongly recommends integrating diagnostics across diseases and programmes to improve patient outcomes everywhere. Integration vastly improves health system efficiency and testing turnaround time, ultimately leading to more effective patient care.
For healthcare systems under strain, it stretches every dollar spent on diagnostics by providing the capacity to generate more results for more patients within an existing network.
Integration comprehensively diagnoses several potential conditions in a “one-stop shop”. It is also a step towards building resilient healthcare systems that are pandemic ready, respond more efficiently to crises like TB and respond to outbreaks with minimal disruption to routine care.
Our history with TB is characterised by centuries of struggle, hardship and societal discord.
We can finally use the innovations at our fingertips to bid farewell to these ancient bacteria that continues to cause unnecessary deaths. If we open our arms a little wider and collaborate for the good of patients across each of Africa’s 54 countries, we can end TB by 2030.
It’s time for us to rewrite history together.
Image (Dr Allan Pamba, Executive Vice President, Diagnostics, Africa at Roche Diagnostics).
