TB is once again the world’s deadliest infectious disease

Tuberculosis is once again the world’s deadliest infectious disease, and the number of people newly diagnosed with TB reached a new high in 2023, according to new global estimates.

Last year, 10.8 million people worldwide got sick with TB, up from 10.1 million in 2020, according to the new analysis from the World Health Organization (WHO).

The number of deaths fell in 2023 but remained high at 1.25 million and surpassed COVID-19 as the top cause of infectious disease deaths for the first time in three years.

TB is an airborne disease caused by a bacteria that usually affects the lungs, and key risk factors include undernutrition, HIV, alcohol abuse, smoking, and diabetes.

The disease can be prevented and cured – but access to diagnostics and treatment varies considerably across the world.

Five countries accounted for 56 per cent of new cases in 2023: India (26 per cent), Indonesia (10 per cent), China and the Philippines (6.8 per cent each), and Pakistan (6.3 per cent).

The hardest-hit regions were Southeast Asia (45 per cent), Africa (24 per cent) and the Western Pacific (17 per cent).

“TB occurs in every part of the world,” Dr Tereza Kasaeva, who leads the WHO’s global TB programme, said during a press briefing.

World not on track to contain TB

Despite the availability of new TB vaccines, treatments, and diagnostics – and the “catastrophic” burden for countries hit hard by TB – Kasaeva said the world is “off track” to stamp it out.

In 2023, the United Nations General Assembly (UNGA) set targets to tackle TB by 2027, including widespread deployment of rapid testing and preventive treatment for groups at risk of infection.

But last year, just 48 per cent of newly diagnosed people had a rapid test. Meanwhile, 21 per cent of their household contacts and 56 per cent of people with HIV – two high-risk groups – had gotten preventive treatment, the analysis shows.

Another challenge is ensuring people can access the right medications at the right time, especially given TB is increasingly becoming resistant to drugs, making it more expensive and difficult to treat.

About 400,000 people are estimated to have developed TB that is resistant to multiple drugs in 2023, but just 44 per cent of them were diagnosed and treated.

“Drug-resistant TB continues to be a public health threat,” Kasaeva said.

Funding shortfalls remain

The UNGA also set a $22 billion (about €19.7) target for TB prevention, diagnostics, and treatment – but as of last year, that budget was only $5.7 billion (about €5.1 billion), or 26 per cent of what is needed.

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Research funding is also not up to par, the report found. The goal is $5 billion (about €4.5 billion), but in 2022 it was $1 billion (about €896 million).

“Global funding for TB prevention and care even decreased in 2023 and remains far below target,” Kasaeva said. “Low and middle-income countries … face significant funding shortages”.

On the bright side, there are six vaccine candidates in late-stage clinical studies, and Kasaeva said she is optimistic that at least one will become available in the coming years.

“There are ongoing clinical trials in the highest-burden countries,” she said. “But the preparations for uptake should start already now”.

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