Extensively drug resistant tuberculosis

Editor—The rising incidence and death rate from tuberculosis, as well as the emergence of multidrug resistant organisms in South Africa and elsewhere,¹ result more from social than medical failure. With living conditions for millions of people remaining at the level of pre-industrial revolution Britain and with inadequate healthcare services that cannot even remotely provide treatment for all who need it in good time and for the full duration required, the problem of multidrug resistance can only get worse.²,³ Longstanding recognition of the reasons for failure of tuberculosis control has had little effect on governments or the corporate world of economic power.⁴,⁵

The substantial economic growth in South Africa since 1994 has been achieved by largely abandoning pre-transition plans for a reconstruction and development programme in favour of neo-liberal economic policies that benefit a limited segment of the population. Many jobs have been lost, new job creation has been limited, and movement towards a social democratic and labour intensive productive industrial state has been inadequate.²

As a result, almost half of all South Africans live in desperate and worsening poverty under conditions that promote the spread of infectious diseases and emergence of multidrug resistance—not only in relation to tuberculosis but also potentially for HIV/AIDS if that treatment programme is not implemented in association with improved primary healthcare facilities.