Global TB Fight Stalls Despite Modest Decline in Cases

Tuberculosis (TB) continues to be the leading cause of death from a single infectious pathogen worldwide, despite decades of effective treatment, according to a new global review. While the number of new TB cases declined slightly in 2024 following disruptions caused by the COVID-19 pandemic, researchers warn that current progress remains far too slow to achieve the World Health Organization’s (WHO) End TB Strategy targets.

The review highlights persistent diagnostic gaps, inadequate funding, drug-resistant disease, and social inequalities as major barriers to eliminating TB.

More than 10 million people developed TB in 2024

The authors estimate that 10.7 million people developed tuberculosis in 2024, including approximately 620,000 people living with HIV. The disease caused an estimated 1.23 million deaths globally, including around 150,000 among people with HIV.

Although global TB incidence fell by 1% between 2023 and 2024, it remains higher than before the COVID-19 pandemic and is well above the trajectory needed to meet the WHO’s 2025 milestones.

Men accounted for more than half of all TB cases, while children continued to represent a substantial proportion of infections, reflecting ongoing community transmission and missed opportunities for early diagnosis.

Case detection has improved but many infections remain hidden

Global case detection improved during 2024, with 8.3 million cases officially notified—equivalent to 78% of the estimated total burden. Expanded use of rapid molecular diagnostics has contributed to this improvement.

However, prevalence surveys continue to identify large numbers of bacteriologically confirmed but asymptomatic cases, suggesting that many infectious individuals remain undiagnosed and continue transmitting the disease.

The review also estimates that around one-quarter of the world’s population has been infected with Mycobacterium tuberculosis. While most will never develop active disease, those with recent infection, HIV, undernutrition, diabetes, or other clinical and social vulnerabilities face a substantially higher risk of progression.

Drug-resistant TB remains a major challenge

Drug-resistant tuberculosis continues to threaten global control efforts.

Of an estimated 390,000 multidrug-resistant or rifampicin-resistant TB cases in 2024, only 42% of patients began treatment. Although treatment success rates improved to 71%, the authors note that many individuals remain undiagnosed or untreated.

Preventive therapy also remains underused. In 2024, tuberculosis-preventive treatment reached 5.3 million people, including 58% of eligible people living with HIV and just 25% of eligible household contacts—well below international targets.

Social determinants continue to drive the epidemic

The review emphasises that TB is driven not only by infection but also by broader social and economic factors.

Undernutrition, poverty, HIV infection, diabetes, smoking, harmful alcohol use, air pollution, migration, and conflict all continue to shape the global burden of disease, particularly in low- and middle-income countries.

Thirty high-burden countries accounted for 87% of all TB cases, with India, Indonesia, the Philippines, China, Pakistan, Nigeria, the Democratic Republic of the Congo, and Bangladesh contributing the largest numbers.

Greater investment is urgently needed

The authors conclude that eliminating tuberculosis will require substantially greater political commitment and financial investment.

Current funding stands at only 27% of global targets, leaving major gaps in prevention, diagnosis, treatment, and public health infrastructure. They argue that expanding proactive case finding, increasing access to preventive therapy, strengthening social protection programmes, and sustaining investment in diagnostics and treatment will be essential if WHO End TB goals are to be achieved.

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