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Nailing TB

By Hoosen Coovadia

We shouldn’t be surprised by recent news that 12% of hospital staff at the largest, government-funded tuberculosis hospitals in KwaZulu-Natal are themselves infected with tuberculosis. The public in South Africa will remember media reports of the tragic consequences of the acquisition of TB by health staff working in health-facility environments where the twin scourges of TB and HIV are ever present. These hazards have to be minimised so that the optimum healthcare can be provided to patients and prevention of TB for staff maximised.

Continuous contact with tuberculosis patients places hospital staff working on the front lines of the TB epidemic at heightened risk of becoming infected. The problem is growing more complex and fragile, underfunded healthcare systems are ill-prepared to manage the problem. A strike by nurses in Swaziland in March was a case in point. The strike was called after the tragic death of Bongani Mavimbela, a nurse at the National TB Hospital who died after contracting TB at work, her colleagues contend. Their rightful demand for workplace safety was placed in balance against the needs of sick patients — a complex and tragic juxtaposition.

The nurses, doctors and hospital staff who dedicate themselves to assisting people with TB deserve to be protected, both now and in the future. Only a healthy work environment will provide an atmosphere for them to deliver compassionate care. Along with the basics of improved ventilation and sufficient supplies of face masks for staff, better and more cost-effective tools to prevent TB are essential. There is currently no effective tuberculosis vaccine that can prevent pulmonary tuberculosis, and the drugs we have are quickly becoming obsolete when faced with drug-resistant TB.

The single most effective weapon in the battle to eliminate TB is a vaccine that could prevent adolescents and adults from developing the disease. Tuberculosis vaccine research is gaining momentum, and much of this work is happening right here in South Africa at the University of Cape Town and other leading research institutions, where clinical trials of promising TB vaccine candidates are under way.

At a well-attended TB conference held in Durban in June, TB advocates elevated the development of new TB vaccines on their agenda. This is a turning point for the TB prevention community and provides an open door for greater participation and collaboration across southern Africa by everyone who recognises that the battle against TB in our hospitals and in our communities will not be won without new vaccines.

The future for TB vaccines is bright, as the South African government and mining communities have signaled the prioritisation of vaccine research and development, recognising that this is a crucial goal for the health and wellbeing of the workforce.

This momentum must be maintained and accelerated, and corporate and government leaders should be reminded of their commitments and urged to follow through on pledges to develop and implement a coordinated plan to develop long-term solutions to the TB epidemic.

Hoosen Coovadia is the director of MatCH (Maternal, Adolescent and Child Health) at the University of the Witwatersrand and Emeritus Professor of Paediatrics and Child Health and Emeritus Victor Daitz Professor of HIV/Aids research at the University of KwaZulu-Natal.