Tuberculosis: A Resurgent Threat and Global Response

Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, primarily affects the lungs but can also impact other parts of the body. For centuries, TB has been a leading cause of illness and death, particularly in low- and middle-income countries. The disease is spread through the air when people with active TB cough, sneeze, or otherwise transmit respiratory fluids.

The recent progress observed is largely attributed to the recovery of essential health services following disruptions caused by the COVID-19 pandemic. However, Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, emphasized that “progress is not victory.” He stated, “The fact that TB continues to claim over a million lives each year, despite being preventable and curable, is simply unconscionable.”

Regional Successes and Persistent Disparities

The WHO African Region has demonstrated significant success, achieving a 28% reduction in TB incidence and a 46% reduction in deaths between 2015 and 2024. Similarly, the European Region experienced a 39% drop in incidence and a 49% reduction in deaths during the same period. Over 100 countries have now achieved at least a 20% reduction in TB incidence, and 65 have seen reductions of 35% or more in TB-related deaths, marking initial milestones in the WHO End TB Strategy.

Despite these encouraging trends, the global burden of TB remains heavily concentrated in a small number of countries. In 2024, 87% of all new TB cases originated in just 30 nations. Eight countries – India (25%), Indonesia (10%), the Philippines (6.8%), China (6.5%), Pakistan (6.3%), Nigeria (4.8%), the Democratic Republic of the Congo (3.9%), and Bangladesh (3.6%) – accounted for 67% of the global total.

What systemic changes are needed to ensure equitable access to TB prevention and treatment in these high-burden countries? And how can global health organizations better support local initiatives to address the unique challenges faced by each region?

Advances in Diagnosis, Treatment, and Prevention

Since 2000, timely treatment for TB has saved an estimated 83 million lives. Recent advancements in diagnosis, prevention, and treatment continue to drive progress. In 2024, 8.3 million people newly diagnosed with TB accessed treatment, representing 78% of those who fell ill. Coverage of rapid TB testing increased from 48% in 2023 to 54% in 2024.

Treatment for drug-susceptible TB remains highly effective, with a success rate of 88%. Furthermore, the number of people developing drug-resistant TB is declining, with over 164,000 receiving treatment in 2024, and treatment success rates improving to 71% from 68% the previous year. Preventive treatment reached 5.3 million people at high risk in 2024, up from 4.7 million in 2023.

The Critical Role of Social Protection and Multisectoral Action

For the first time, the WHO has reported on progress toward social protection targets established at the 2023 UN High-Level Meeting on TB, utilizing data from the International Labour Organization (ILO). Coverage varies dramatically among the 30 high-burden countries, ranging from 3.1% in Uganda to 94% in Mongolia, with 19 countries reporting coverage rates below 50%.

Addressing the underlying drivers of the TB epidemic – including undernutrition, HIV infection, diabetes, smoking, and alcohol use – requires a coordinated, multisectoral approach. Poverty and other structural determinants also play a significant role.

Funding Gaps Jeopardize Future Progress

Despite the gains made, global progress remains far from the targets set by the End TB Strategy. A major obstacle is the stagnation of global funding for TB. In 2024, only US$5.9 billion was available for prevention, diagnosis, and treatment – just over a quarter of the US$22 billion annual target for 2027.

Projected cuts to international donor funding pose a serious threat. Modelling studies suggest that these cuts could lead to up to 2 million additional deaths and 10 million new TB cases between 2025 and 2035. Global TB research funding also lags, reaching US$1.2 billion in 2023 (24% of the target). However, research efforts are expanding, with 63 diagnostic tests and 29 drugs in development, and 18 vaccine candidates undergoing clinical trials, including 6 in Phase 3.

Dr. Tereza Kasaeva, Director of the WHO Department for HIV, TB, Hepatitis and STIs, warned, “We are at a defining moment in the fight against TB. Funding cuts and persistent drivers of the epidemic threaten to undo hard-won gains, but with political commitment, sustained investment, and global solidarity, we can turn the tide and end this ancient killer once and for all.”

Frequently Asked Questions About Tuberculosis