It’s Time To End Tuberculosis In Nigeria

The infectious disease that killed the most people last year is one many people have heard almost nothing about: tubercu­losis.

In 2023, it claimed 1.25 million lives around the world, with 125,000 in Nigeria. And yet, in rich countries—where virtually nobody dies from tuberculo­sis any longer—attention has moved on.

Even in poorer countries, where the wealthier can afford treatment, it is often the poor­est, most disconnected and disadvantaged who suffer from this disease.

Therefore, it is good that Health Minister Prof. Muham­mad Ali Pate is putting more focus on tuberculosis.

This week in Abuja, he is hosting health ministers from all around the continent and the world for an incredibly import­ant Africa High-Level Regional Dialogue on financing to end tuberculosis.

The world has long prom­ised to do better. As part of the UN’s global goals, known as the Sustainable Development Goals, all nations promised to fix almost every global problem by 2030, tuberculosis among them. That’s not going to happen. With respect to tuberculosis, we will be decades late.

Indeed, we are failing on al­most all the world’s 2030 promis­es. Based on current trends, the world will be more than half a century late delivering on all its promises.

The reason is clear: politi­cians made an impossible 169 promises, but having 169 prior­ities is indistinguishable from having none.

Crucial targets on nutrition, education, and tuberculosis are put alongside much more pe­ripheral promises like boosting recycling, more urban parks, and promotion of lifestyles in harmony with nature.

The world has already entered the second half for its 2030 promises, yet it will be no­where near halfway. It is time to identify and prioritise the most crucial goals.

My think tank, the Copenha­gen Consensus, is doing exactly that: Together with several Nobel laureates and more than a hundred leading economists, we have been working for years to identify where each naira can do the most good.

A new, peer-reviewed study shows that a dramatic reduction in tuberculosis is not only possi­ble but is one the most effective priorities leading up to 2030.

Almost a quarter of all people in the world carry the tuberculosis bacteria. Even in rich Europe and the USA, every tenth person has it.

For most well-off, well-nour­ished people, it will not develop into disease, but it is a risk for the less fortunate. In that way, tuberculosis is a disease of hun­ger and poverty.

Each year, more than ten million people develop tuber­culosis. Because of a lack of resources, in 2021, we only diag­nosed about 6 million cases, of which about 205,000 came from Nigeria.

Almost half of the people who are untreated will go on to die. Those who don’t die will continue to spread the infection — on average, actively infected people can infect five to fifteen others through close contact over a year.

Moreover, the six million who are diagnosed and offered treat­ment are in for a rough time. They must take medication for as long as six months. Because the medication clears the im­mediate tuberculosis symptoms like fevers and weight loss in a couple of weeks, many will drop out of treatment too early.

When people stop treatment too early, it not only increases the chance that the disease can be passed on to others, it also makes the surviving tubercu­losis bacteria more likely to develop drug resistance. This means the next treatment could require 18‒24 months of treat­ment and will be much costlier.

We can do much better. It’s possible to diagnose many more people and ensure most TB pa­tients stay on their medication.

Our new study shows this can be achieved for an additional US$6.2 billion annually.

It is less than what the world has already promised — al­ready in 2018, the UN promised to increase funding by about US$7-8 billion annually by 2022. Disappointingly, spending since 2018 has declined.

The additional US$6.2 billion annually can deliver diagnosis, care, and prevention that will achieve the world’s tuberculosis promises.

It would ensure at least 95% of people with tuberculosis will receive a diagnosis. It can provide simple ways to make sure people complete their six months of medication—perhaps with incentives to complete the treatment, such as food, cloth­ing, juice boxes, or gift cards, or through support groups for patients to encourage each other. These days, apps on your cellphone can also help.

The extra resources will mean that high-risk, vulnera­ble populations will be able to access periodic screening.

Over the coming decades, 50 million people will access appropriate treatment and 35 million people will have access to preventive treatment.

This will dramatically reduce tuberculosis deaths by 90%. It will essentially wipe out tuber­culosis, as we should have done decades ago.

Up to mid-century, the addi­tional resources will allow us to avoid an astounding 27 million deaths, along with untold hu­man suffering.

The total benefits, expressed in economic terms, mostly from avoided deaths, would reach US$3 trillion. Each dollar spent will generate $46 of social bene­fits for the world.

Global dithering has allowed tuberculosis to become the big­gest infectious killer.

Ending TB is one of the world’s most effective policies. We have promised way too much for 2030, but tackling tuberculosis is one of the few, most effective policies we must carry through.

Remember that the world has long promised to do better. As part of the United Nation’s global goals, known as the Sus­tainable Development Goals, all nations promised to fix almost every global problem by 2030, tuberculosis among them.

That’s not going to happen. With respect to tuberculosis, we will be decades late.

Indeed, we are failing on almost all the world’s 2030 promises.

Based on current trends, the world will be half a century late delivering across all its prom­ises.

The reason is clear: politi­cians made an impossible 169 promises. But having 169 prior­ities is indistinguishable from having none.

This year, the world will be at halftime for its 2030 promises, but nowhere near halfway. It is time to identify and prioritize the most crucial goals. My think tank, the Copenhagen Con­sensus, is doing exactly that: together with several Nobel laureates and more than 100 leading economists, we have been working for years to identi­fy where each dollar can do the most good.

A new, peer-reviewed study shows that a dramatic reduc­tion in tuberculosis is not only possible but would be one of the most effective priorities leading up to 2030.

Bjorn Lomborg is President of the Copenhagen Consensus and Visiting Fellow at Stanford University’s Hoover Institution. His new book is “Best Things First.”