HQ Team
October 30, 2024: Tuberculosis has emerged as the world’s top infectious disease with about 8.2 million people newly diagnosed with the illness last year — the highest on records since WHO began global monitoring in 1995.
This represents a notable rise from 7.5 million reported in 2022, placing tuberculosis “as the leading infectious disease killer in 2023, surpassing COVID-19,” according to a statement from the World Health Organization.
“The fact that TB still kills and sickens so many people is an outrage when we have the tools to prevent it, detect it and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO urges all countries to make good on the concrete commitments they have made to expand the use of those tools and to end TB.”
The WHO’s Global Tuberculosis Report 2024 stated mixed progress in the global fight against tuberculosis, with persistent challenges such as significant underfunding.
Global funding for prevention and care decreased further in 2023 and remains far below target. Low- and middle-income countries (LMICs), which bear 98% of the tuberculosis burden, faced significant funding shortages.
Only $5.7 billion of the $22 billion annual funding target was available in 2023, equivalent to only 26% of the global target.
55% cases in men
While the number of tuberculosis-related deaths decreased from 1.32 million in 2022 to 1.25 million in 2023, the total number of people falling ill with tuberculosis rose slightly to an estimated 10.8 million in 2023.
With the disease disproportionately affecting people in 30 high-burden countries, India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%) and Pakistan (6.3%) together accounted for 56% of the global tuberculosis burden.
According to the report, 55% of people who developed the disease were men, 33% were women, and 12% were children and young adolescents.
In 2023, the gap between the estimated number of new tuberculosis cases and those reported narrowed to about 2.7 million, down from Covid-19 pandemic levels of around 4 million in 2020 and 2021.
This follows substantial national and global efforts to recover from Covid-related disruptions to tuberculosis services. The coverage of tuberculosis preventive treatment has been sustained for people living with HIV and continues to improve for household contacts of people diagnosed with tuberculosis.
Drug resistance
However, multidrug-resistant tuberculosis remains a public health crisis. Treatment success rates for multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) have now reached 68%. But, of the 400,000 people estimated to have developed MDR/RR-TB, only 44% were diagnosed or got access to treatment in 2023.
The total amount of international donor funding in low- and middle-income countries has remained at around $1.1–1.2 billion per year for several years.
The United States government remains the largest bilateral donor for tuberculosis (TB). While the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) contribution to international funding of the TB response, especially in LMICs, is important, it remains insufficient to cover essential TB service needs.
The report emphasised that sustained financial investment was crucial for the success of TB prevention, diagnosis, and treatment efforts.
Globally, TB research remains severely underfunded, with only one-fifth of the $5 billion annual target reached in 2022.
Catastrophic costs
“This impedes the development of new TB diagnostics, drugs, and vaccines. WHO continues leading efforts to advance the TB vaccine agenda, including with the support of the TB Vaccine Accelerator Council launched by the WHO Director-General,” according to the report.
For the first time, the report provides estimates on the percentage of TB-affected households that face catastrophic costs (exceeding 20% of annual household income) to access TB diagnosis and treatment in all low- and middle-income countries.
A significant number of new TB cases are driven by five major risk factors: undernutrition, HIV infection, alcohol use disorders, smoking (especially among men), and diabetes.
Tackling these issues, along with critical determinants like poverty and GDP per capita, requires coordinated multisectoral action, according to the report.
“We are confronted with a multitude of formidable challenges: funding shortfalls and catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics, and drug-resistant tuberculosis, a significant driver of antimicrobial resistance,” said Dr Tereza Kasaeva, Director of WHO’s Global Tuberculosis Programme.
“It is imperative that we unite across all sectors and stakeholders, to confront these pressing issues and ramp up our efforts,” she said.
