World TB Day: Germany’s commitment to ending tuberculosis

How does German Development Cooperation contribute to the fight against the planet’s deadliest infectious disease?

Zolelwa Sifumba tells the story of her fight to beat multidrug-resistant TB

While the world is gripped by the spread of COVID-19, tuberculosis which has been around for centuries kills more people than any other infectious disease. Today, Germany is one of the main contributors to the global fight against it. On the occasion of World TB Day 2020, Healthy DEvelopments takes a closer look at the challenge and Germany’s contribution to stamping out the disease.

‘TB is a problem for all of us - because we all breathe. If we don’t fight, then who will fight?’
Dr Zolelwa Sifumba from South Africa contracted multi drug-resistant tuberculosis (TB) as a medical student in 2012 and was devastated to learn that the success rate for the treatment at the time was just 40 percent. ‘TB and its treatment is able to reduce a person to feeling that it’s either they must end their life or the TB will end it for them. Or the medication for the TB will end it,’ she said.

For 18 months, she suspended her studies in order to follow treatment, which was eventually successful. Today, she is a doctor campaigning for greater action to fight TB around the world.

Tuberculosis kills more people than any other infections disease

Transmitted through droplets from coughs, sneezes or just talking, TB is both preventable and curable disease. Nonetheless it claims the lives of over 4,000 people every day, in 2018, killing 1.5 million people, and infecting an estimated 10 million worldwide (WHO, 2020). Today the success rate for Multi Drug Resistant (MDR)-TB treatment has improved, but still remains low at 55%.

‘TB is seen to be a dirty disease that can only infect a certain kind of person,’ Sifumba says, ‘but the truth is that anyone can get TB.’

In 2018, the United Nations set itself an ambitious goal: to find and treat 40 million people with active TB between 2018 and 2022, and provide preventive treatment for 30 million people with latent TB – particularly vulnerable people, for example children and people living with HIV. In setting the new targets, world leaders acknowledged that much more is needed to be done if we are to eliminate TB as an epidemic by 2030.

How does Germany contribute to the fight against TB?

Germany helps in the global campaign against TB through financial and technical cooperation with international partners. One of its most important partners in this endeavour is the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Germany takes a proactive role in the Fund’s Governance. On behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), KfW Entwicklungsbank helps establish reference laboratories, hospitals and assists with vaccine development and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) supports hospital partnerships addressing TB in 11 partner countries in Asia and Africa.

Working with the Global Fund

A community health worker in Dodoma, Tanzania, on the daily look out for TB cases

GFATM is the world’s biggest financier of AIDS, TB, and malaria prevention, treatment, and care programmes - activities closely linked to the sustainable development goal SDG 3 (‘Ensure healthy lives and promote well-being for all at all ages’), and in particular the sub goal 3.3 (‘By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.)
Today, Germany is the fourth largest government contributor to the GFATM. It is part of the Global Fund Board, and also a member of the Strategy Committee. In these positions and together with other partners it is playing a pivotal role in shaping Global Fund policies, notably on building resilient and sustainable systems for health, on improving the governance of national coordination mechanisms and on ensuring the correct use of funds through risk management.

From 2002 to 2019, Germany has disbursed a total €2.92 billion. For 2020-2022, Germany pledged €1 billion – a 17.6% increase from its previous commitment. Its investments have helped the Global Fund partnership save more than 32 million lives and reduce deaths from TB, AIDS and malaria, on average, by 40 percent.

Supporting the development of vaccines

The standard treatment for drug-resistant TB at present includes highly toxic medications which have to be taken for up to two years. The potential negative side effects include the possibility of permanent deafness, while the medications have a limited cure rate of between 25-50 percent (Economist, 2019). To tackle this, BMZ is also contributing EUR 10 million to the Global Health Investment Fund (GHIF), which promotes the development and launch of new drugs and vaccines, including vaccines against TB for adults and children.

On behalf of the German Federal Ministry of Education and Research (BMBF), KfW is accelerating the development and availability of urgently needed new drugs by working together with TB Alliance, a not-for-profit product development partnership dedicated to the discovery and development of new, faster-acting and affordable TB medicines.

Establishing laboratories across central Asia and in East Africa

Through KfW, Germany helped in the establishment of national reference laboratories in Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan and Pakistan - all countries with high rates of drug-resistant TB which previously had inadequate or non-existent laboratory capacities for specialist diagnoses. This measure helps to improve the diagnosis and treatment of various forms of TB in accordance with WHO standards. In the same countries, German assistance also helps to set up TB treatment facilities.

Community health worker Sophia Mpande responsible for TB education and referrals

In cooperation with the East African Community, KfW is also helping to set up a network of national reference laboratories. These are complemented by mobile laboratory units which can be sent to regions where outbreaks are suspected, using state-of-the-art technology in compliance with the required safety standards.

A strong partner committed to help ending TB

Since 2016, BMZ has been supporting TB containment in eleven partner countries in Eastern Europe and Sub-Saharan Africa (including Moldova, Namibia, Tanzania, Ethiopia, Côte d’Ivoire, Ghana, Guinea, Cameroon, Kenya, Liberia, Malawi) through the ‘Hospital Partnerships – Partners Strengthen Health’ initiative. Medical, nursing and laboratory staff from German and partner hospitals collaborate at eye level, learning from each other and joining forces in their commitment to help end TB.

TB, like COVID-19, is ‘a problem for all of us’ – and it takes international collaboration to master an effective response. Commenting on the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria in October 2019, Development Minister Gerd Müller said: ‘The fight against AIDS, TB and malaria is a battle that can be won - Germany is doing its part.’

Inna Lazareva, 12 March 2020

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