Sunday Times (Johannesburg) - September 10, 2006
Brett Horner and Bobby Jordan

A MASSIVE anti-TB initiative involving private firms, civil society and the government was culled two years ago by Health Minister Manto Tshabalala-Msimang.

The Coalition Against TB (CAT), a network of mining firms, drug companies and TB watchdog groups, was formed amid huge fanfare, but never took off after the Health Department withdrew its support.

Two years later, specialists are dealing with yet another TB crisis, this time in KwaZulu-Natal where a new, untreatable and lethal strain of the disease has so far claimed scores of lives.

Although the reasons for scrapping the anti-TB initiative are unclear, senior health professionals believe the move was politically motivated - and further evidence of Tshabalala-Msimang's disastrous approach to healthcare.

The most senior national health officials - including the head of the national TB control programme, Lindiwe Mvusi - did not attend a vital meeting in Johannesburg this week to discuss the potentially catastrophic new TB strain that experts believe is already widespread in South Africa. The national department was allegedly upset that the meeting was arranged in conjunction with "outsiders" - the World Health Organisation and the US Centres for Disease Control and Prevention.

The emergence of the strain comes five months after the department launched its National TB Crisis Management Plan, in response to plunging cure rates and rising infections. Health figures put the annual infection rate at about 300000 a year. However, only a fraction of those with TB - about 8000 - are benefiting from the government's crisis plan, according to Department of Health figures. Experts say the CAT programme would have had a significantly larger outreach.

Instead, the department is now playing catch-up and, in response to the new strain, this week had to take urgent steps to order two new anti-TB drugs.

Members of the scuppered initiative said the Health minister had been particularly unhappy with the appointment of the former South African Medical Association (Sama) secretary-general, Dr Moji Mogari, as chairman of the nine-member CAT committee. The medical association had made itself unpopular by criticising departmental policies, mainly around HIV/Aids and the overhaul of the pharmaceutical industry.

This week Mogari declined to comment on reasons for the project's demise, but said he believed Tshabalala-Msimang had made a politically motivated decision.

"It was a great pity," he said. "I'm not saying CAT would have solved all the problems, but it would have had a great impact."

Mogari said he enjoyed a good relationship with Tshabalala-Msimang, but added she had "reservations" about Sama and "stakeholders I represented".

Other former CAT committee members were angry.

Mary Edginton, an associate professor at the Wits School of Public Health and one of the government representatives on the CAT committee, said a concerted effort was made by all to establish the venture, which even saw rival TB drug companies Sandoz and Aventis pledging their support.

She said numerous meetings and workshops were convened with all the participants, including the Health Department, and a gala dinner was held to launch CAT.

But the function left local organisers red-faced in the presence of overseas dignitaries when Tshabalala-Msimang, invited to deliver the keynote address, failed to arrive. From then on, Edginton said, "it all fizzled away".

Former fellow committee member David Nish, a representative of the South African National Tuberculosis Association, said the initiative would have been a promising antidote to the government's waning effort to eradicate the disease.

"The coalition was going to unite all sectors in the fight against TB à the [government] clinics just can't handle it."

Health Department spokesman Sibane Mngadi said the U-turn by the government was not a conscious decision made by any one person. "Not everything that reaches the planning stage will lead to concrete action."

Mngadi denied that personal tensions between the minister and CAT organisers were behind the programme's demise.

The department had since established smaller public-private partnerships with various firms and organisations that it found easier to implement, he said.

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