Social and systemic failures blamed for ongoing TB crisis

Tuberculosis continues to haunt South Africa despite decades of treatment advances, with health experts warning that the disease is thriving in the same conditions that have fuelled poverty, overcrowding and unequal access to healthcare on a sustained basis in the country.

The warning comes as global tuberculosis statistics revealed that 10.7 million people fell ill with TB during 2024, while 1.5 million people died from the disease, making it the world’s deadliest infectious killer. South Africa remains among the countries hardest hit by TB, particularly because of the close relationship between tuberculosis, HIV infection and vulnerable living conditions.

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Dr Avron Urison, chief medical officer at 1Life Insurance, said the continued spread of TB could not be blamed on a lack of medicine.

“The reasons are not limitations in medical treatment but rather social and systemic failures. We continue to underinvest in prevention, early diagnosis and sustained treatment, especially in low-income communities,” he said.

‘We continue to underinvest in prevention’

Urison said many people still struggled to reach clinics or remain on treatment programmes because of transport costs, overcrowded healthcare facilities and weak primary healthcare systems.

“In many underprivileged communities, TB programmes are underfunded, primary healthcare systems are weak, and clinics are not easily accessible, particularly for people living in rural areas. This often results in late diagnosis or patients dropping out of treatment,” he said.

South Africa’s high HIV infection rate has further fuelled the crisis. According to Urison, people with weakened immune systems remain far more vulnerable to developing active TB after infection.

“Poverty and overcrowded living conditions further accelerate the spread of the disease. At the same time, the country’s health system is under strain, with staff shortages and uneven access to diagnostic services leading to delays in much-needed care,” he said.

Dr Avron Urison, chief medical officer at 1Life Direct. Picture Supplied

Global health figures estimate that between five and 10 per cent of people infected with TB bacteria will eventually develop active tuberculosis. Urison said fear and stigma continued to keep many people away from testing, even though early detection remains one of the most effective ways to reduce transmission.

“Many people do not have accurate information about how TB is transmitted, or that it is both contagious and treatable. As a result, symptoms are often ignored or misunderstood,” he said.

Symptoms still ignored or misunderstood

He added that some patients concealed their diagnosis because they feared discrimination from employers, relatives and communities.

“This stigma directly contributes to delayed diagnosis, continued transmission and a higher risk of severe illness or even death,” he said.

Urison also warned that international funding cuts affecting South African HIV and TB programmes could weaken support for vulnerable groups who already faced barriers to healthcare.

“Although there has been progress in supporting people living with TB and HIV, those with diabetes are often overlooked. It is important that stronger integration takes place across all health programmes and protects these high-risk groups,” he said.

He also cautioned that misconceptions around medical insurance could discourage people from seeking help or disclosing a diagnosis.

According to Urison, some policyholders feared that testing positive for TB would automatically lead to higher premiums or rejected cover, even though this was not necessarily true. He said withholding medical information from insurers could create even greater financial problems later if claims were disputed during serious illness.

“It is important for policyholders to disclose their full medical history to their insurer to avoid being left vulnerable if a claim is rejected when it is most needed. By being transparent about medical conditions, individuals are better able to protect themselves and their families financially during challenging times,” he said.

Play open cards with your medical aid

Urison said preventative measures remained important, even in poorer communities where healthy living was often difficult to maintain. He encouraged people to seek check-ups, complete treatment programmes, and take symptoms seriously before the disease progressed into illness.

“Ending TB will require increased efforts to ensure that no group is left behind. Encouraging community involvement to reduce stigma and integrating TB care with other health services are essential,” he said.

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