Tuberculosis
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OVERVIEW
Tuberculosis (TB) is an ancient adversary that continues to pose a devastating global health challenge. In 2023, an estimated 10.8 million people fell ill with TB worldwide, and a staggering 1.25 million lives were lost. This makes TB the world's leading cause of death from an infectious disease, surpassing COVID-19 and HIV/AIDS. It is also the leading cause of death among people living with HIV, and a major contributor to deaths related to antimicrobial resistance.
TB is caused by the bacterium Mycobacterium tuberculosis. It spreads through the air in tiny droplets released when someone with active TB of the lungs coughs, sneezes, speaks or even sings; inhaling just a few of these germs can lead to infection. About a quarter of the world’s population are silent carriers of TB, but weakened immunity or poor living conditions can flip latent infection into active, highly contagious disease - usually in the lungs, yet capable of attacking almost any organ.
The impact of TB is disproportionately felt in low- and middle-income countries, which account for 95% of new cases and 98% of deaths. South-East Asia (45%), Africa (24%), and the Western Pacific (17%) bear the highest burden. Beyond the tragic loss of life, TB inflicts immense socio-economic damage, leading to lost work time and significant reductions in household income. For families who lose a loved one to TB, approximately 15 years of income are lost due to the premature death, further compounding their suffering and creating a vicious cycle that undermines development.
Despite ambitious targets set by the WHO's End TB Strategy - including a 90% reduction in TB incidence and a 95% reduction in TB mortality by 2035 - progress remains insufficient. While global efforts have saved an estimated 79 million lives since 2000 and led to a decline in TB deaths from 2.3 million in 2000 to 1.3 million in 2022, the TB incidence rate is estimated to have increased by 4.6% between 2020 and 2023, reversing previous declines. This is a worrying reversal that makes the 2035 targets increasingly unattainable in some regions.
TB’s funding gap remains a critical barrier. The Global Plan to Stop TB (2006-15) faced a significant shortfall, and this problem persists. In 2023 estimates showed that $22 billion was required annually for TB prevention, diagnosis, treatment, and care, but only $5.7 billion was available - a colossal annual funding gap of over $16 billion. An additional $5 billion per year is needed for TB research, with only $1bn committed. This makes TB one of the most neglected global health issues in terms of funding relative to its burden.
Adding to the urgency is the escalating crisis of drug-resistant TB (DR-TB), which does not respond to standard treatments and is a leading cause of antimicrobial resistance (AMR)-associated deaths. In 2022, 160,000 people died from DR-TB, with a disheartening treatment success rate of just over 60%. DR-TB is largely a man-made phenomenon resulting from inadequate treatment; its unchecked spread poses a direct threat to both global TB control and overall health security, including for wealthy nations.
The historical success in wealthy countries - where improvements in sanitation, housing, and effective drug treatments led to a dramatic decrease in TB mortality by the 1950s (around 90% in Europe) - demonstrates that with sustained effort and investment, the disease can be brought under control. Renewed commitment, increased funding, and accelerated research into new vaccines are essential to end this preventable and curable disease.
A full report coming soon will dive into the data, country success stories, and ideas for ways to help…
RESOURCES
Leading Organisations and Initiatives
There are many excellent organisations and initiatives working to combat TB. Here are some of our top picks:
The Global Fund to Fight AIDS, Tuberculosis and Malaria: A major financing institution providing significant funding for TB programs in low- and middle-income countries.
Gavi, the Vaccine Alliance: Involved in assessing the potential impact of new TB vaccines and working towards their equitable delivery. They have highlighted the significant health and economic benefits a new effective TB vaccine could bring.
Stop TB Partnership: A global partnership of more than 1,700 members, including national governments, international and civil society organisations, working to end TB. They were instrumental in developing the Global Plan to Stop TB.
World Health Organisation (WHO): The leading global authority defining the End TB Strategy, setting targets, and providing guidelines for prevention, care, and control. They produce annual Global TB Reports with comprehensive data.
TB Vaccine Accelerator Council: Launched by the WHO Director-General in 2023, this council aims to facilitate the development of, and equitable access to, new TB vaccines.
Further reading
If you’ve read Albion East’s report on TB and want to dive into more detail, here are some of our top picks:
How new vaccines could revolutionise our relationship with tuberculosis (Gavi, the Vaccine Alliance)
WHO's end of TB targets: unachievable by 2035 without addressing undernutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022 (BMC Public Health)
Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae (The Lancet Global Health)
Shifting from tuberculosis control to elimination: Where are we? What are the variables and limitations? Is it achievable? (International Journal of Infectious Diseases)
