World should focus on fighting tuberculosis

US President Donald Trump's spending freeze on foreign aid marks a significant challenge for the international development community, and many experts warn that diseases will surge. During these times of uncertainty about the future role of the world's biggest donor, the Global Fund stands as a beacon of hope. Since the beginning of this millennium, the Geneva-based multilateral organization has been fighting one of humanity's oldest scourges, infectious diseases — specifically the three big killers, malaria, HIV and tuberculosis.

Through targeted funding and innovative strategies, the Global Fund has made significant breakthroughs in malaria and HIV treatment. The time is ripe now for the Global Fund to sharpen its focus on tuberculosis.

Nearly one-third of the Global Fund's 2023-25 budget, totaling about $4.17 billion, has been allocated to the fight against malaria. These funds have supported large-scale distribution of insecticide-treated bed nets and conducting of rapid diagnostic tests, drastically reducing transmission rates. As a result, countries such as Rwanda and Zambia have seen a remarkable decline in malaria cases and deaths.

For HIV treatment, the Global Fund is spending $6.48 billion, or nearly half of its allocations. In the past decade, the fund has facilitated access to antiretroviral therapy for millions of people, helping to transform HIV from a fatal disease into a manageable chronic condition. By promoting education and prevention, particularly in vulnerable communities, the Global Fund has empowered individuals to take control of their health.

Together, these efforts have saved countless lives and advanced global health security. But it is now time to reassess its funding allocation. Tuberculosis prevention and control has been allocated $2.4 billion or just 18 percent of the Global Fund's budget — and has received less funds than those for HIV or malaria treatment every year since the Global Fund was created.

But tuberculosis today kills more people than HIV and malaria combined. It is by far the world's leading killer infectious disease. Not only do malaria and HIV receive far more resources from the Global Fund than tuberculosis; they also get much more global publicity and media coverage. Tuberculosis, in comparison, is a neglected, often ignored and even forgotten scourge.

To understand why, we need to look at the history of tuberculosis. For people in the rich world today, the disease is little more than a dim memory of a bygone era. But there was a time when tuberculosis was frightful. In the 1800s, tuberculosis caused a tsunami of deaths, killing one in every four persons across Europe and the United States. For most of the 1800s, New York City's tuberculosis death rate alone was higher than the total death rate in the city today. Throughout the 1800s, tuberculosis was a much bigger killer than the COVID-19 pandemic in its peak year. Over the past two centuries, tuberculosis has likely killed 1 billion people.

Yet antibiotics and a vaccine administered in childhood, combined with improved living standards, rudimentary public health measures, and subsequent treatment breakthroughs, mean that the disease has been largely eradicated in wealthier countries.

As a result, tuberculosis has mostly lost the attention of the rich world. Not so for the world's poorer half, where tuberculosis still claims nearly 1.3 million lives every year. For comparison, that number is higher than the combined death toll of HIV/AIDS (630,000) and malaria (619,000).

For more than half a century, we have known how to cure tuberculosis. Yet it persists and kills a record number of people in the poorer regions of the world. It mostly kills adults in their prime, leaving children without parents.

Tuberculosis has become an illness of poverty. It spreads when people live in close quarters and are unable to afford space, and it thrives among populations that cannot afford basic healthcare and welfare services. The most vulnerable, those living in slums, migrant areas, mining towns and prisons, are also the most voiceless. Tuberculosis has gone from threatening the lives of all to just killing those that nobody cares enough about.

Needless to say, this shouldn't be the case. We know how to defeat the disease. It would take surprisingly few resources to do so. Research for the Copenhagen Consensus think tank shows that an additional expenditure of $6.2 billion annually could save about 1 million lives a year over the coming decades, making it one of the very best possible development policies.

This spending would enable much broader diagnosis to prevent onward infections, and ensure most tuberculosis patients stay on medication, reducing deaths by 90 percent by 2030. The benefits, including the decline in the numbers of deaths and tuberculosis cases, outweigh the healthcare and time costs by 46 to 1.

The Global Fund is in the middle of its three-year replenishment cycle, when it asks the world for more resources. The world needs to be generous because the Global Fund has shown that it is one of the very best ways to provide global good.

The Global Fund, as well as development agencies everywhere, needs to focus more on the illness that is claiming more lives than other diseases, and where investment can deliver an astonishing return.

Aaron Motsoaledi is South Africa's minister of health, and Bjorn Lomborg is president of the Copenhagen Consensus. The views don't necessarily reflect those of China Daily.

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