After years of progress, tuberculosis (TB) has once again become the deadliest infectious disease worldwide, surpassing COVID-19, which had temporarily held that title. The World Health Organization (WHO) recently published its 2024 Global Tuberculosis Report, revealing that TB claimed an estimated 1.25 million lives in 2023, while COVID-19 caused approximately 320,000 deaths. This dramatic shift underscores the persistence of TB and has led to renewed demands for global action.
A Persistent Threat: TB’s Ongoing Toll on Global Health
TB has long been one of humanity’s deadliest pathogens, and though it was briefly overshadowed by the COVID-19 pandemic, the disease continues to exact a heavy toll. According to the WHO report, TB deaths decreased slightly from 1.32 million in 2022 to 1.25 million in 2023. Yet, the decline is small and insufficient given the available resources to combat TB. The number of new TB cases rose sharply to 8.2 million in 2023, marking the highest number of annual diagnoses since the WHO began systematic monitoring in 1995.
Why Are TB Cases Rising Again?
The COVID-19 pandemic created disruptions in TB services, leading to underdiagnosis and untreated cases worldwide. This period of restricted healthcare access caused a backlog of undiagnosed cases. Public health experts like Dr. Anand Date from the CDC suggest that these disruptions, coupled with population growth, may explain the surge in TB diagnoses in 2023. This delay in diagnosis and treatment has contributed to the resurgence of TB and its rising death toll, with countries still struggling to catch up.
The Socioeconomic Stigma and Barriers to TB Treatment
TB disproportionately affects impoverished and marginalized populations, including migrants, low-income workers, and vulnerable communities. WHO Director-General Dr. Tedros Adhanom Ghebreyesus recently condemned the disease’s persistence, highlighting the injustice of preventable deaths due to a lack of resources. The stigma surrounding TB, along with factors such as malnutrition, diabetes, and smoking, makes it harder for those affected to seek or receive adequate treatment. According to Dr. Luke Davis of Yale’s School of Public Health, social determinants play a crucial role in TB’s persistence, as the disease often worsens in people with compromised immune systems and poor living conditions.
Funding Gaps: The Key Obstacle to Eradicating TB
A lack of financial support remains one of the primary obstacles to fighting TB effectively. The 2023 UN high-level meeting on TB set ambitious funding targets, but significant shortfalls remain. According to the WHO, global funding for TB dropped from $6 billion to $5.7 billion in 2023, far below the estimated $22 billion needed annually for optimal prevention, diagnosis, and treatment programs. The WHO report emphasizes that increased investment from both domestic and international donors is essential to close these gaps.
Why Funding Matters: Expanding Diagnostic and Treatment Accessibility
Adequate funding would enable the expansion of rapid diagnostic tests, which could facilitate faster and more accurate diagnoses and minimize delays in treatment. Currently, the lack of accessible and affordable diagnostic tools forces many patients to travel long distances, wait for days for results, or forego testing entirely. Increased funding could also help compensate families for the financial burden associated with seeking treatment, covering costs like lost wages, travel, and food expenses that prevent many from pursuing care.
Furthermore, an increase in funding would enhance research initiatives to develop new TB treatments and vaccines. The current annual budget for TB research hovers around $1 billion, far short of the $5 billion target set for 2027. The WHO highlights the promise of recent innovations, emphasizing the potential impact of additional funding to speed up research and bring new therapies to patients.
The Role of Countries in Combating TB: A Call for Domestic Investment
Countries burdened by TB must also contribute to the fight against the disease, especially middle-income nations where TB rates are high but international support is limited. Médecins Sans Frontières (MSF) recently reported that many countries still need to implement WHO-recommended guidelines, particularly in treating TB in children. Out of 14 high-burden countries surveyed, only five had adopted comprehensive guidelines for early pediatric TB diagnosis. Enhanced national funding could bridge these policy gaps, ensuring vulnerable populations receive timely and appropriate care.
Promising Vaccine Research: Hope on the Horizon
While there has only been one TB vaccine available in the last century — the BCG vaccine, which has limited effectiveness in adults — recent progress offers hope. Over a dozen TB vaccine candidates are in development, including one in a late-stage clinical trial funded by the Gates Medical Research Institute. The M72/AS01E vaccine, currently in phase 3 trials, could become the first new TB vaccine in over 100 years if proven effective. However, without adequate funding, even the best vaccines may not reach the people who need them most.
Janeen Madan Keller of the Center for Global Development emphasizes the need for policy reform to ensure equitable access to vaccines in countries with high TB rates. While organizations like Gavi, The Vaccine Alliance, cover vaccine costs in some of the world’s poorest nations, many middle-income countries fall outside these programs’ eligibility criteria. According to Keller, aligning policies and resources in preparation for potential vaccine approvals will be essential to maximize the impact of new immunization strategies.
Breaking Barriers to Progress
Experts argue that solving the TB crisis requires a concerted effort to address both medical and socioeconomic factors. Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership, points out that every time a breakthrough in TB treatment or prevention seems within reach, new challenges arise. With increased global awareness and commitment, however, advocates hope the world can finally eliminate the social and economic barriers that hinder TB eradication efforts.
The resurgence of TB as the world’s leading infectious killer has galvanized a renewed sense of urgency among global health leaders. As the WHO report makes clear, comprehensive funding, policy adjustments, and targeted interventions are necessary to put an end to this ancient, yet still lethal, disease.