In 2023, tuberculosis (TB) surpassed COVID-19 as the leading cause of infectious disease-related deaths globally, marking a significant shift that underscores the ongoing and complex challenge of eradicating TB. This update, published by the World Health Organization (WHO), serves as a stark reminder that TB, a preventable and treatable illness, still claims millions of lives annually and continues to place an enormous burden on healthcare systems, particularly in low- and middle-income countries.
The WHO’s report highlights that in 2023 alone, approximately 8.2 million people were newly diagnosed with TB, a record-breaking number since global TB monitoring began in 1995. Despite this increase in diagnoses and access to treatment, the goal of eradicating tuberculosis remains distant, hindered by issues like funding shortages and the persistence of multidrug-resistant TB (MDR-TB).
Tuberculosis: An Overview
Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis. It primarily attacks the lungs, but it can also infect other parts of the body, including the spine, brain, and kidneys. Spread through the air when an infected person coughs, sneezes, or even sings, TB is highly contagious, particularly in close-contact environments. TB symptoms vary, depending on which part of the body is affected, but common symptoms include a persistent cough (often producing blood), chest pain, weakness, fatigue, weight loss, fever, and night sweats. When untreated, TB can be fatal; however, it is often preventable and treatable with a regimen of antibiotics.
The disease exists in two forms: latent TB infection and active TB disease. People with latent TB are infected but do not show symptoms and cannot transmit the bacteria to others. In contrast, those with active TB are symptomatic and contagious, especially in environments with inadequate ventilation. Treatment typically renders a person non-contagious within two to three weeks, but the duration and success of treatment depend on the TB strain and the individual’s health, among other factors. Individuals with weakened immune systems, such as those living with HIV/AIDS, are particularly susceptible to TB and may face severe complications if infected.
Rising TB Infections Despite Treatment Availability
According to WHO, the number of people diagnosed with TB rose to 8.2 million in 2023, up from 7.5 million in 2022. This is the highest annual figure since WHO began monitoring global TB trends. However, despite increased diagnosis and treatment, the goal of eradicating TB is still far off, as the disease continues to affect large populations worldwide. The overall number of people who fell ill with TB also increased slightly to 10.8 million, underscoring that while diagnostic and treatment measures have expanded, new infections remain prevalent.
One reason for the rise in cases is the persistence of undiagnosed infections. The gap between estimated and reported TB cases narrowed to about 2.7 million in 2023, down from roughly 4 million during the COVID-19 pandemic’s peak years of 2020 and 2021. While this reduction reflects improved detection and reporting systems, millions of cases still go unreported. These undiagnosed individuals pose a risk of continued transmission, particularly in communities with high population density or limited healthcare access.
The Global Toll of TB: Mortality and Morbidity
TB-related deaths dropped slightly from 1.32 million in 2022 to 1.25 million in 2023, a minor improvement but still alarmingly high. TB’s mortality rate, particularly in areas with high HIV/AIDS prevalence, remains devastating. For many, co-infection with HIV severely exacerbates the effects of TB, increasing the likelihood of severe illness and death. WHO estimates that low- and middle-income countries bear 98% of the global TB burden, with the disease predominantly affecting marginalized populations who face social and economic barriers to accessing care.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus expressed frustration at the high rates of TB-related illness and death, especially since the tools to prevent, diagnose, and treat TB exist. “The fact that TB still kills and sickens so many people is an outrage,” Dr. Ghebreyesus said, emphasizing the urgent need for intensified action, innovative approaches, and adequate funding.
Challenges in the Global Fight Against TB
Several factors contribute to the challenges in eradicating TB, despite the availability of effective treatments. Funding shortages are a significant issue, especially in low- and middle-income countries that face the greatest burden. Health infrastructure in these regions is often under-resourced, limiting the reach of TB diagnosis, treatment, and prevention programs. Furthermore, MDR-TB has emerged as a public health crisis. This form of TB, which does not respond to the most commonly used drugs, requires a longer and more complex treatment regimen. Treatment for MDR-TB can last up to 18 months or more, often with side effects that can discourage patients from completing their treatment course.
The COVID-19 pandemic also disrupted TB control efforts, as resources were diverted, diagnostic services were interrupted, and healthcare systems were overwhelmed. Although TB case detection and reporting have improved since the pandemic’s peak, COVID-19’s impact on TB programs may take years to overcome fully.
Funding and Policy Gaps
WHO’s report notes that without adequate funding, global TB eradication goals are unlikely to be met. The funding needed to tackle TB includes support for healthcare workers, diagnostic tools, new treatments, and patient support services. Investments in TB research have increased in recent years, but they still fall short of what is required to develop better diagnostics, shorter and more effective treatment regimens, and potential vaccines. WHO has set ambitious milestones for reducing TB-related illness and deaths, aiming for significant progress by 2027. However, with current funding and policy gaps, meeting these goals remains uncertain.
Innovative Solutions and the Way Forward
To address these issues, health organizations and researchers are exploring innovative solutions. Newer diagnostic tools, such as GeneXpert machines, allow for rapid detection of TB and MDR-TB, potentially reducing the delay between diagnosis and treatment initiation. Additionally, WHO has recommended shorter treatment regimens for drug-sensitive TB, which can improve patient adherence and reduce transmission. However, expanding access to these newer diagnostics and treatments requires substantial investment, particularly in underserved regions.
On a broader scale, ending TB also demands addressing the social determinants of health that fuel its spread. Poverty, malnutrition, and limited healthcare access all contribute to TB’s persistence in high-burden regions. Comprehensive strategies that integrate TB care with HIV/AIDS services, improve nutrition, and enhance living conditions are essential components of a successful TB eradication strategy.
Public Awareness and the Role of Communities
Public awareness is another critical element in TB control. Misunderstandings about TB transmission, symptoms, and treatment can prevent people from seeking timely diagnosis and care. Community-based TB programs have shown promise in reaching underserved populations, providing education, and supporting treatment adherence. In some countries, community health workers play a vital role in monitoring patients, distributing medication, and offering support to ensure patients complete their treatment courses.
The role of governments and international organizations cannot be overstated. Policy makers must prioritize TB funding, especially for MDR-TB, and work to implement policies that make TB care accessible and affordable for all. International partnerships are also crucial, as TB does not respect borders and requires a coordinated response.
