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Organizing to Battle Drug-Resistant TB




 

South African mines are incubating a deadly form of tuberculosis that is spreading world-wide.

Cape Town, South Africa

Leaders of southern African nations are meeting in Mozambique this week to plan an unprecedented attack on an ancient foe: tuberculosis. Fueled by new drug-resistant strains and the HIV/AIDS pandemic, TB is spreading like wildfire through South Africa's mines and to the world beyond.

Extensively drug-resistant TB - a deadlier form of the airborne disease, one that can overpower nearly all available drugs - first emerged in South Africa in 2008. It has since been discovered in 84 countries, including the United States and much of Europe. With a concerted and coordinated response from governments, the mining industry, international development partners and civil society, we can stop this disease in its tracks.

The way to start is by strengthening efforts to detect and treat TB in southern Africa's mines. With $2.5 trillion in mineral reserves, South Africa has the largest mining sector in the world. Migrant workers from neighboring countries come here in droves to extract gold, diamonds, chromite, vanadium and coal.

The work can be devastatingly toxic for the body. South Africa's 500,000 mine workers have the highest recorded rate of TB among any demographic in the world. The conditions that give rise to such epidemics also fed recent strikes in our platinum mines, which descended into tragedy and dozens of deaths in August in the country's Marikana region.

Working conditions in the mines are inhumane and untenable. While underground, miners breathe in silica dust that can inflame and damage their lungs and weaken their immune system. Because they live and work in cramped spaces, the cough of one person infected with TB can circulate for hours while others breathe it in. Miners are also at risk of being infected with both HIV and TB. Sex work is common surrounding the all-male hostels where miners live. When HIV damages the immune system, a dormant TB infection quickly advances into contagious TB disease.

Miners then return home and spread the disease to their families and communities. In this way, mine-associated TB gives rise to 760,000 new cases annually in Africa. Inadequate and interrupted treatment can then lead to drug-resistant strains of the disease.

This takes a heavy economic toll. According to a study commissioned by the Southern African Development Community, TB costs South Africa alone $886 million each year in health-care costs and in impoverishment when family providers are too sick to work, or die.

That is why SADC leaders representing 15 nations have resolved to strengthen TB control efforts in Africa's mining sector. This summer, they signed a declaration committing themselves to address the epidemic. The concrete steps they pledged to take include identifying TB in migrant workers, improving cross-border treatment for them and their communities, and creating an effective system for compensating workers for illness acquired on the job.

African governments should be commended for taking this initiative, but they cannot succeed alone. The mining industry and labor unions, for instance, will benefit greatly from healthier employees - and a cooperative effort to safeguard the health of miners and their communities could also foster reconciliation between the groups.

Many international development partners, such as the U.S. government, are engaged in the global fight against TB. But budget deficits have forced cuts to TB-control programs. As President Obama embarks on his second term, I hope the resolve of SADC governments to fight TB reinvigorates America's commitments.

The World Bank also must play a leading role. On his first trip as the president of the World Bank, Dr. Jim Kim - himself a TB expert - traveled to South Africa in September. He said that the World Bank has "the world's deepest bench of development experts" for confronting the challenges posed by the unchecked spread of TB in our mines, and can "convene all the relevant partners and help build a truly regional response to an epidemic that does not respect borders." Dr. Kim should match these inspiring words with bold action and create a new financing stream targeted on TB - just as the World Bank has done for malaria and HIV/AIDS.

The study commissioned by the SADC estimates that South Africa alone could save $783 million year in increased productivity and lower health costs if proven inventions are implemented to stop TB in the mining sector. Throughout the region, avoiding the disease could help millions of Africans climb out of poverty in our lifetimes.

After knowing for more than a century that the South African mining industry is rich with TB, we finally have the political will in the region to create an emergency response to arrest its spread. For the health of the region - and to protect a world at greater risk from TB - we must seize the opportunity and end this disease.

Archbishop Tutu is the archbishop emeritus of Cape Town, South Africa.



 


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Information in this article was accurate in November 7, 2012. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.