In the latest turn of an unlikely controversy, the Government has postponed a mass culling of badgers to stem transmission of bovine tuberculosis to cattle. Fortunately, human health is for the most part safe – we rarely contract the bovine form of TB.
The form of TB that does affect people, however, is still a very real threat worldwide. It kills about 1.4 million people each year. It is more common than the bovine form, and drug-resistant strains are breeding and spreading.
The badger controversy reminds us that if we are serious about eliminating the threat of TB to humans – and its deadly drug-resistant forms – we must step up controls efforts in the epicentres of the disease. One of them is South Africa’s mining sector, which is churning out approximately 760,000 new TB cases each year.
concentrated epidemic of TB among the half-million workers in South Africa’s gold, diamond and coal mines is responsible for Africa’s having the highest TB death rates in the world. Gold miners are 15 times more likely than people in the general population to have TB, according to the South African Chamber of Mines, and the crowded conditions in which miners live and work, along with the silica dust they inhale in their workplace, increase the risk of infection.
South Africa’s mines are the economic powerhouse of the entire region, attracting migrant workers from neighbouring states including Lesotho, Mozambique and Swaziland. As Aaron Motsoaledi, South Africa’s Health Minister, has put it, ‘the head of the TB snake is in South Africa, with its fangs in the country’s mines and its tail reaching out to neighbouring countries.’
A migrant worker with TB will typically spread the infection to 10 to 15 other people each year that he’s sick. When he returns to his home community, he may not have access to health services capable of putting patients through the necessary six months of TB treatment.
When treatment is interrupted, drug resistance quickly develops – and curing one case of drug-resistant TB can cost up to £2,300 – more than 100 times what it costs to treat a normal case.
The World Health Organisation says South Africa already has one of the worst epidemics of multidrug-resistant TB in the world – strains of TB that are resistant to the two most powerful anti-TB drugs. The high co-infection rate of TB and HIV complicates matters further. In 2011, 75% of the 430,000 people living with HIV in Africa who died of TB died in Africa. In South Africa, more than three out of five TB patients are also HIV-positive, fighting two diseases at once.
A thriving mining sector is vital for Africa’s socioeconomic development – which in turns strengthens healthcare systems to keep deadly diseases in check. Yet according to a recent study commissioned by the Southern African Development Community (SADC), the TB epidemic alone is costing South Africa £550 million a year in lost productivity, absenteeism, training and associated health costs. Implementing more effective anti-TB measures could eliminate those costs and increase productivity, bringing a total financial benefit of £488 million per year.
An emergency response is needed – and it must be an aggressive and united effort from mining companies, governments, development partners, and civil society. Earlier this year, SADC leaders took a crucial first step, signing a Declaration on TB in the Mining Sector that calls for specific regional actions.
Among current problems identified were: lack of access to basic health and social services; the absence of effective cross-border medical referral systems; inadequate legal protection for mineworkers; no occupational disease compensation for TB or silicosis; and, despite on-site TB treatment now offered to working miners by their employers, lack of continued care after miners return home, and transfer of the burden of care onto families and communities.
SADC health ministers have just met in Mozambique to expand their political initiative and develop a practical code of conduct, to be ratified in 2013, in order to accompany the declaration. Bold leadership in coordinating a response will transform the fight against this ancient scourge.
The UK should play a leading role in the response. We are home to some of the largest mining companies in the world, many of which have vested interests in Africa’s extractive industries. Through the Department for International Development, our Government already plays a leading role in in scaling up TB treatment and prevention efforts in Africa.
The urgent task now is to coordinate our initiatives against TB and, in line with the SADC Declaration, step up regional efforts to find and treat all TB-affected African miners. Together, we can seize this opportunity to mount a historic challenge to TB – and resign it to the history books once and for all.