Tuberculosis: A Resurgent Global Health Crisis

Tuberculosis (TB), a bacterial infection primarily affecting the lungs, has surged to alarming levels, with the World Health Organization (WHO) reporting approximately 8.2 million new cases in 2023. This marks the highest number recorded since WHO began monitoring the disease in 1995, surpassing the previous year’s figure of 7.5 million. As TB reclaims its position as the leading infectious disease killer, surpassing even COVID-19, the global health community faces a pressing challenge.

The Global Landscape of TB

The rise in TB cases is not confined to one region; it is a global phenomenon. The latest provisional data from the UK Health Security Agency (UKHSA) indicates a 12.5% increase in TB notification rates across the UK in 2023, the largest year-on-year increase since 2000. Scotland experienced the most significant rise at 41.2%, while England saw an increase of 11.0%. Despite these increases, the UK’s TB rates remain relatively low compared to other countries, with 7.84 cases per 100,000 population, still below WHO’s threshold of 10 per 100,000.

In the United States, the situation is similarly concerning, with 2022 recording the highest number of TB cases in a decade. The disease, caused by the bacteria Mycobacterium tuberculosis, spreads through the air when infected individuals cough, sneeze, or spit. Just inhaling a few germs can lead to infection, making TB a highly contagious disease.

Symptoms and Impact

Common symptoms of TB include a persistent cough lasting over three weeks, chest pain, and coughing up blood. Other signs include fatigue, fever, night sweats, loss of appetite, and weight loss. TB is particularly deadly for individuals with HIV, contributing significantly to antimicrobial resistance. Despite being treatable with antibiotics, TB continues to claim approximately 1.5 million lives annually, equating to an average of 2.5 deaths per minute.

The WHO’s Global Tuberculosis Report 2024 reveals mixed progress in the fight against TB. While TB-related deaths decreased from 1.32 million in 2022 to 1.25 million in 2023, the total number of people falling ill with TB rose slightly to an estimated 10.8 million. The disease disproportionately affects 30 high-burden countries, with India, Indonesia, China, the Philippines, and Pakistan accounting for 56% of the global TB burden.

The Challenge of Drug Resistance

One of the most pressing issues in the fight against TB is the rise of multidrug-resistant TB (MDR-TB). In the UK, resistance to antibiotics used to treat TB has increased, with the highest number of individuals resistant since 2013. Globally, only 44% of the estimated 400,000 people with MDR-TB were diagnosed and treated in 2023. This resistance complicates treatment efforts and underscores the urgent need for new strategies and funding.

Funding Shortfalls and Economic Impact

Despite the clear need for increased resources, global funding for TB prevention and care has decreased further in 2023, falling far short of targets. Low- and middle-income countries, which bear 98% of the TB burden, face significant funding shortages. Only £4.5 billion of the £17.4 billion annual funding target was available in 2023, representing just 26% of the global target. The economic impact of TB on affected households is severe; estimates indicate that half of TB-affected households in low- and middle-income countries face catastrophic costs exceeding 20% of their annual income for diagnosis and treatment.

Addressing the Root Causes

Five major risk factors are driving new TB cases: undernutrition, HIV infection, alcohol use disorders, smoking (especially among men), and diabetes. Addressing these issues requires coordinated multisectoral action. The WHO emphasizes the importance of uniting across all sectors and stakeholders to confront these pressing challenges.

The Path Forward

Doctor Tedros Adhanom Ghebreyesus, WHO Director-General, has called for countries to expand the use of existing tools to prevent, detect, and treat TB. The gap between estimated new TB cases and those reported has narrowed to about 2.7 million in 2023, down from around four million during the COVID-19 pandemic. This improvement follows substantial efforts to recover from pandemic-related disruptions to TB services.

However, the report highlights that global milestones and targets for reducing the TB disease burden are off-track. Considerable progress is needed to meet targets set for 2027 ahead of the second UN High-Level Meeting. WHO calls on governments, global partners, and donors to urgently translate commitments made during the 2023 UN High-Level Meeting on TB into tangible actions.

Conclusion

The resurgence of tuberculosis as a leading global health threat demands immediate attention and action. With the right investments in research, treatment, and prevention, it is possible to turn the tide against this ancient disease. As the world grapples with the complexities of TB, it is imperative that we unite to confront the challenges and work towards a future where TB is no longer a leading cause of death. The time to act is now.