Businesses Exposed to Tuberculosis Risk
Francesca Boldrini, former Director, Head of Global Initiative, World Economic Forum & Dr François Bonnici, former Associate Director, Global Initiative, World Economic Forum

An ancient, cunning predator is proving to be the thorn in the side of many companies’ efforts to contain the HIV/AIDS epidemic. Tuberculosis (TB) is now a leading cause of death and morbidity among people who are HIV positive, accounting for at least one-third of AIDS-related deaths in Africa.

What this proves is that TB is far from under control. Despite TB being preventable and curable, the disease has become a global pandemic due to its deadly synergy with HIV, as well as woefully inadequate investment in control, surveillance and R&D. In countries with a high adult HIV prevalence, the rates of new TB cases have more than quadrupled since 1990. Clearly, the TB-HIV epidemic is overwhelming the efforts of countries and businesses, and lacking much-needed resources.

The cumulative productivity loss of individual and business earnings from TB, independent of the impact of HIV/AIDS, is estimated to have a global economic impact of about US$ 12-16 billion every year.

According to the World Economic Forum’s Global Business Survey of almost 11,000 business leaders, only 30% of businesses with HIV/AIDS workplace programmes have parallel TB programmes. Not only does this expose a major gap in the provision of workplace programmes but it puts companies and their employees at grave risk – a risk which is intensified by the recent emergence of extreme drug resistant strains of TB (XDR-TB) in HIV-positive populations in South Africa.

The parameters surrounding TB control have been exposed and left vulnerable to the dangers of this “double plague”. Infection control measures must be strengthened everywhere, especially where HIV prevalence is high, to protect at-risk communities and those at risk of XDR-TB infection. There is a great need for enhanced collaboration between TB and HIV/AIDS programmes in the provision of a continuum of quality care for employees with, or at risk of, tuberculosis and people living with HIV/AIDS. It seems that even in settings where HIV prevalence is high, tuberculosis and HIV/AIDS programmes have largely pursued separate courses.

To harmonize these programmes, businesses have the opportunity to take a leadership role in finding practical solutions to implementing TB-HIV co-management strategies. For example, the introduction of DOTS services in workplace settings should, as much as possible, utilize or build on existing facilities or arrangements that are already in place to provide vital treatment to employees in their respective workplaces.

What is encouraging is that with HIV causing an explosion in the number of TB cases globally, businesses are starting to take notice. In fact, 81% of African business leaders have expressed concern over the impact of TB on their business in the next five years and 31% are seriously concerned. However, companies need to do more to reverse the cumulative productivity loss of individual and business earnings from TB and protect their most valuable assets – their employees.

For example, in 2003, AngloGold South Africa estimated that each case of TB among its employees in the Vaal River and West Vilts operations cost US$ 410 in lost shifts. The company implemented a comprehensive TB control programme for the workforce, spending about US$ 90 per employee each year, but generating a savings of an additional US$ 105 through the prevention of active TB among HIV-positive employees. Prompt diagnosis and effective treatment of both diseases led to net cost savings by reducing absenteeism and preventing disease transmission. By making the fight against TB and HIV/AIDS a business priority, companies can harness their resources to positive effect.

Programmes like the GHI’s China Health Alliance, a groundbreaking initiative that has the support of the Chinese Ministry of Health and brings together a number of companies and non-governmental organizations in a joint effort to respond to the growing economic and social threat of HIV/AIDS and TB in China, have been very successful. The GHI has also pioneered the India Business Alliance to Stop TB (IBA), which was set up in 2004 with the aim of increasing the involvement of the private sector in TB control. Over the past two years, the IBA has reached a staggering 4 million people by using a combination of workplace and community programmes to provide critical diagnosis and treatment to those in need.

TB control efforts have been severely hampered by the escalating HIV/AIDS epidemic to the extent that TB has now been declared an emergency on the African continent. The increasing occurrence of XDR-TB and HIV is likely to further worsen both HIV and TB treatment efforts. A dangerous cycle of infection is the devastating outcome. Addressing major health issues is thus critical to breaking the vicious cycle of poverty in the developing world. With greater TB and HIV/AIDS workplace management in areas most in need, business can rapidly accelerate the response to this scaling epidemic.

We hope more business leaders keep taking up this challenge and will get involved. There is a lot they can do to help.