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.

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.

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.

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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. 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. 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.

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