Drug-resistant TB is a growing threat

Health authorities in Papua New Guinea are working to contain an outbreak of tuberculosis that is resistant to nearly all drugs. This super-deadly form of the airborne disease was first discovered in South Africa in 2008. It has since been detected in 84 countries around the world – including here in Australia.

While it seems incredible that millions are still impacted by this ancient scourge, the threat of TB remains very real. It is the world's biggest infectious killer, second only to HIV/AIDS, claiming 1.4 million lives each year.

TB is a global epidemic; it demands a global response. The Australian government should be commended for its regional efforts to control TB.

However, Australia can and should do more with global partners to expand its fight against TB. Key regions demand an emergency response to control TB and contain drug resistance – starting with South Africa's mining sector, which accounts for approximately 760,000 new TB cases each year.

In southern Africa, the mines are at the centre of a perfect storm of physical and social conditions in which TB can flourish and spread.

Miners working deep underground breathe stale air in which infectious germs can circulate for hours after every cough. TB spreads easily through the crowded dormitories in which the miners live while on site.

Many of them already have silicosis, a disease contracted from breathing in silica dust while mining, which damages the lungs and weakens the immune system. HIV, which also targets the immune system, is high among a male population working far from home.

Damaged immune systems cause dormant TB infection, which many of the miners carry already, to explode into contagious disease. Those with silicosis are three times more likely to develop TB disease – and those with HIV, up to 30 times more likely. Without treatment, 83 per cent of HIV patients that contract TB will be dead within six months.

Because miners tend to be migratory labourers, they also act as a wellspring of infection for whole swathes of a continent. Every sick miner is estimated to infect up to 15 other people in his community each year – women, children, families, and friends.

All this movement also makes it tough to cure TB in miners. A person sick with TB must take pills for six months to clear all of the bacteria. If a worker who is being treated returns home to a community without health services and stops medication, drug-resistance develops – just as it has in Papua New Guinea. The cost of treating resistant forms of TB skyrockets, and the side effects for those drugs are severe.

The scale of TB – and the spread of its drug-resistant forms – isn't just a humanitarian crisis. It is a serious obstacle to economic development. To grow, economies need healthy, productive workers. This is why the 15 Heads of State comprising the Southern African Development Community (SADC) have resolved through a formal Declaration to join forces against TB in the mines.

The measures proposed in the SADC Declaration can only be delivered through a strong public-private partnership. They include more robust case detection and treatment, the setting up of cross-border referral systems, legal protection for miners, including occupational disease compensation, greater supervision of treatment post-employment and better access to health care and social services beyond the mines.

Cooperation with global development partners – both through aid and technical assistance – will be critical to success. As we contemplate the role Australia should play, consider that Foreign Minister Bob Carr recently devoted nearly $5 million to the "Extractive Industries Technical Advisory Facility," a multi-donor trust run by the World Bank that helps developing countries optimize their mining operations to support socioeconomic development.

Alongside aid and technical assistance to build capacity in developing countries' mines, Australia – together with global development partners and mining companies – could provide aid and technical assistance to help SADC countries control mine-related TB in southern Africa. These efforts would have the same fundamental goal: to ensure that "mining wealth drives future prosperity," in Minister Carr's own words.

It is estimated that TB costs the South African mining sector $835 million per year. Tackling TB in mines – as outlined in the SADC Declaration – would wipe out this cost and boost productivity, resulting in a total financial benefit of $755 million per year.

Fighting TB at one of its epicentres in South Africa's mines would also help minimize the global spread of drug-resistant strains, something that should concern Australians as we grapple with a regional outbreak of extensively drug-resistant TB.

Mining companies, African governments, international donors, and civil society must work together to ensure a sustained commitment to fighting TB – starting in African mines, and building up to a concerted global response to stop TB wherever it rears its head. We can defeat this disease. The SADC Declaration has paved the way. Now we must take action.