Tuberculosis: The “Bridesmaid Disease” Still Awaiting Its Turn for Global Attention
Despite being preventable and curable for over a century, tuberculosis (TB) continues to claim more lives than any other infectious disease worldwide. With over 1.2 million deaths reported in 2024 alone, TB remains a persistent global health crisis, particularly in regions like South Africa, where it is the leading cause of death. Yet, this ancient disease continues to languish in the shadows of other health priorities, described by Professor Kogie Naidoo as “the ever-patient bridesmaid awaiting its turn.”
A Preventable Crisis Overshadowed
First identified in 1882, Mycobacterium tuberculosis, the bacterium behind TB, has long been understood by scientists. Despite breakthroughs in prevention and treatment, TB remains a leading killer, claiming over 4,000 lives daily. Yet, funding for TB research pales in comparison to other diseases. In 2021, COVID-19 received over $100 billion for vaccine development, while TB, which kills more people annually, secured just $1 billion for research—less than $200 million of which went toward vaccine development.
Professor Naidoo, Deputy Director at the Centre for the AIDS Programme of Research in South Africa (CAPRISA), emphasizes that this disparity isn’t about pitting one disease against another. Instead, it’s about highlighting the neglect of a disease that disproportionately affects the world’s most vulnerable populations.
South Africa’s TB Burden
South Africa bears a particularly heavy TB burden, with over 54,000 deaths reported in 2024 out of the global total of 1.2 million. The country’s TB incidence remains stubbornly high, exacerbated by its HIV co-infection crisis. TB is responsible for 70% of deaths among people living with HIV, despite South Africa hosting the world’s largest HIV treatment program.
The socio-economic factors driving TB’s persistence are stark. With unemployment at 31.9%, poverty, food insecurity, and homelessness create fertile ground for TB transmission. Cape Town, for example, reported nearly 30,000 TB cases in 2024—more than the combined totals of the US, UK, France, and Canada.
The Missing Cases
A critical challenge in combating TB is the alarming number of undiagnosed cases. Nearly half of TB cases in South Africa have unknown outcomes, largely because many people either avoid testing or fail to return for their results. This fuels ongoing transmission, perpetuating the cycle of infection.
The healthcare system’s limitations compound the problem. Diagnostic tests like sputum and GeneXpert require patients to return to clinics, often within 24 to 72 hours. For individuals facing economic hardship or transportation barriers, this is a significant hurdle. Decentralized, community-wide testing and treatment strategies could help close this gap, but such initiatives are costly and resource-intensive.
A Call for Holistic Solutions
TB is not just a medical issue; it’s a symptom of societal dysfunction. The WHO’s End TB Strategy underscores the need for bold policies, government stewardship, and community engagement. For the first time, the WHO has also incorporated nutrition into its TB guidelines, recommending food assistance for households in food-insecure settings.
South Africa’s overburdened public healthcare system cannot tackle TB alone. Social relief measures, including poverty alleviation and improved living conditions, must be part of the conversation.
A Shifting Finish Line
While progress has been made—including more efficient diagnostics, shorter treatment regimens, and promising vaccine development—the fight against TB remains an uphill battle. Each gain shifts the finish line further away, requiring renewed vigor and sustained investment.
The COVID-19 pandemic demonstrated what rapid, collaborative scientific action can achieve. TB, by contrast, serves as a stark reminder of what happens when urgency and resources are lacking.
As World TB Day approaches, Professor Naidoo calls for a renewed commitment to science, innovation, and evidence-based programs. “TB reminds us what happens when urgency is absent,” she warns. “It’s time to ensure TB is no longer the bridesmaid, but finally the bride.”
— Reported by Nexio News
