I. Overview of Global Tuberculosis 

Tuberculosis (TB) is a global health concern that demands our attention. According to the World Health Organization's Global tuberculosis report 2024, the disease has shown a complex set of trends and challenges.

In 2023, TB likely reclaimed its position as the world's leading cause of death from a single infectious agent, following a brief period during which COVID-19 took the lead. Each year, over 10 million people continue to fall ill with TB, and the numbers have been on the rise since 2021.

The global TB incidence rate in 2023 was 134 (95% uncertainty interval [UI]: 125–145) per 100,000 population. While this was only a very small (0.2%) increase compared to 2022, it reflects the ongoing impact of the COVID-19 pandemic on TB diagnosis and treatment. Regionally, trends vary, with the rate increasing in the Americas and the Western Pacific regions in 2023, while showing declines or stabilization in other regions like the WHO African Region which has seen a decline in the rate every year since 2010.

Most of the people developing TB in 2023 were located in the WHO regions of South-East Asia (45%), Africa (24%), and the Western Pacific (17%).

 Geographically, 30 high TB burden countries accounted for 87% of all estimated incident cases worldwide, with India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), and Pakistan (6.3%) being the top five countries contributing to 56% of the global total.

Drug-resistant TB remains a significant threat. Globally, the estimated annual number of people developing multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) was relatively stable between 2020 and 2023, estimated at 400,000 (95% UI: 360,000–440,000) in 2023. Five countries - India, the Russian Federation, Indonesia, China, and the Philippines - accounted for more than half of these cases.

The estimated global number of deaths caused by TB fell for a second consecutive year in 2023, but TB remains a major killer. In 2023, it caused an estimated 1.25 million deaths (95% UI: 1.13–1.37 million), including 1.09 million among HIV-negative people and 161,000 among people with HIV. The COVID-19 pandemic is estimated to have resulted in almost 700,000 excess deaths from TB between 2020 and 2023 compared to pre-pandemic trends.

Progress towards global targets set by the WHO's End TB Strategy and the UN Sustainable Development Goals has been mixed. For example, the net reduction in the TB incidence rate between 2015 and 2023 was 8.3%, far from the 50% reduction milestone set for 2025. Similarly, while the treatment success rate for drug-susceptible TB remains high at 88% and has improved to 68% for MDR/RR-TB, coverage of various aspects like rapid testing for TB, TB treatment, and TB preventive treatment still fall short of the targets set for 2027.

Diagnostic testing for TB also shows areas for improvement. In 2023, a WHO-recommended rapid diagnostic test (WRD) was used as the initial test for 48% of the 8.2 million people newly diagnosed with TB globally, indicating a need to expand the use of such rapid tests. Additionally, the global coverage of HIV testing among people diagnosed with TB remained high at 80% in 2023.

Overall, ending the global TB epidemic remains a distant goal, but efforts in various aspects such as strengthening diagnosis, treatment, and preventive measures, along with addressing social determinants and investing in research, are crucial to making significant progress towards this goal.

2. Commitments and Strategies for Global Tuberculosis Prevention and Control

Tuberculosis (TB) remains a significant global health concern. According to the World Health Organization's Global tuberculosis report 2024, TB has likely regained its position as the world's leading infectious disease killer after being surpassed by COVID-19 for a few years.

Current Global Burden

1. In 2023, an estimated 10.8 million people (95% uncertainty interval [UI]: 10.1–11.7 million) fell ill with TB (incident cases). Although this represents a continued increase from previous years, the rate of increase has slowed and started to stabilize compared to the more rapid rises seen during the peak of the COVID-19 pandemic disruptions. For instance, the global TB incidence rate (new cases per 100,000 population per year) increased by just 0.2% between 2022 and 2023, following declines of about 2% per year between 2010 and 2020.
2. Geographically, the highest numbers of people developing TB in 2023 were in the WHO regions of South-East Asia (45%), Africa (24%), and the Western Pacific (17%). The 30 high TB burden countries accounted for 87% of all estimated incident cases worldwide, with India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), and Pakistan (6.3%) being the top five countries that together accounted for 56% of the global total.
3. In terms of age and sex distribution, adult men (aged ≥15 years) had the highest burden with an estimated 6.0 million cases (95% UI: 5.5–6.4 million) in 2023, equivalent to 55% of the estimated total. Women (aged ≥15 years) accounted for 3.6 million cases (95% UI: 3.3 - 3.9 million, 33% of the total), and children and young adolescents (aged 0–14 years) had 1.3 million cases (95% UI: 1.2–1.3 million, 12% of the total).

Drug-Resistant TB

1. Drug-resistant TB continues to pose a major public health threat. Globally, the estimated annual number of people who developed multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) was relatively flat between 2020 and 2023 after a slow downward trend between 2015 and 2020. In 2023, it was estimated at 400,000 (95% UI: 360,000–440,000). Five countries accounted for more than half of these cases: India (27%), the Russian Federation (7.4%), Indonesia (7.4%), China (7.3%), and the Philippines (7.2%).
2. The proportion of people with TB who have MDR/RR-TB has shown some changes, with a decrease seen particularly among those with a previous history of treatment. In 2023, the estimated proportion was 3.2% (95% UI: 2.5–3.8%) among new cases and 16% (95% UI: 9.0–24%) among those previously treated, compared to 4.1% (95% UI: 3.1–5.0%) and 20% (95% UI: 11–30%) in 2015 respectively.

TB-Related Deaths

1. The estimated global number of deaths caused by TB fell for a second consecutive year in 2023, reversing the increases that occurred during the worst period of COVID-related disruptions in 2020 and 2021. In 2023, TB caused an estimated 1.25 million deaths (95% UI: 1.13–1.37 million), including 1.09 million among HIV-negative people (95% UI: 0.98–1.20 million) and 161,000 among people with HIV (95% UI: 132,000–193,000).
2. By region, the WHO African and South-East Asia regions accounted for 80% of the global number of deaths caused by TB among HIV-negative people in 2023, with India alone accounting for 29% of such deaths. The patterns of TB deaths also vary across different regions, with some showing continued declines, while others had increases or flat trends during different periods of the pandemic and its aftermath.

Diagnosis and Treatment

1. In 2023, 8.2 million people were newly diagnosed with TB and officially notified as a TB case, which is the highest number since WHO started compiling data in the mid-1990s. This increase likely reflects the diagnosis of a backlog of cases delayed by COVID-19 disruptions as well as an actual increase in the number of people developing the disease.
2. However, there are still gaps in diagnosis and treatment. The use of WHO-recommended rapid diagnostic tests (WRD) as the initial test for newly diagnosed TB cases was only 48% globally in 2023, although this is a slight improvement from previous years. Also, while the global coverage of HIV testing among people diagnosed with TB remained high at 80% in 2023, efforts are still needed to ensure that everyone with TB gets timely and appropriate treatment.
3. TB treatment coverage, which can be approximated by comparing the number of newly diagnosed and reported cases to the estimated number of incident cases, has seen some improvement over the years but still has room for growth. In 2023, the gap between the estimated number of people developing TB and those newly diagnosed was 2.7 million, although this is narrower than in 2020 when it widened due to pandemic-related disruptions.

Overall, while there have been some positive trends in the global TB response, such as the stabilization of incidence rates in some regions and improvements in diagnosis and treatment in certain aspects, significant challenges remain. The world is still far from achieving the targets set by the End TB Strategy and the commitments made at the 2023 UN high-level meeting on TB. There is an urgent need for continued efforts across multiple sectors, including increased funding for prevention, diagnosis, treatment, and research, as well as actions to address the social and economic determinants of TB to turn the tide against this ancient killer.

3. Key Findings and Messages on Global Tuberculosis

Tuberculosis (TB) is a global health concern that demands urgent attention. According to the World Health Organization's (WHO) Global tuberculosis report 2024, TB has likely regained its position as the world's leading infectious disease killer.

The report highlights several key aspects regarding the global TB situation. Firstly, the number of people falling ill with TB has been on the rise since 2021. In 2023, an estimated 10.8 million people (95% uncertainty interval [UI]: 10.1–11.7 million) developed TB (incident cases). While the rate of increase has slowed and started to stabilize compared to the period during the COVID-19 pandemic, it remains a significant challenge. Geographically, the highest numbers of TB cases in 2023 were in the WHO regions of South-East Asia (45%), Africa (24%), and the Western Pacific (17%).

Drug-resistant TB continues to pose a major public health threat. Globally, the estimated annual number of people developing multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) was relatively stable between 2020 and 2023. In 2023, it was estimated at 400,000 (95% UI: 360,000–440,000). Five countries, namely India, the Russian Federation, Indonesia, China, and the Philippines, accounted for more than half of the global number of people estimated to have developed MDR/RR-TB in 2023.

In terms of TB deaths, there was a positive trend in 2023 as the estimated global number of deaths caused by TB fell for the second consecutive year, reversing the increases seen during the worst period of COVID-related disruptions in 2020 and 2021. However, TB still remains a significant cause of mortality, with an estimated 1.25 million deaths (95% UI: 1.13–1.37 million) in 2023, including 1.09 million among HIV-negative people and 161,000 among people with HIV.

The report also focuses on the progress towards various targets set by the WHO's End TB Strategy and the commitments made at the 2023 UN high-level meeting on TB. For instance, the net reduction in the TB incidence rate between 2015 and 2023 was 8.3%, which is far from the 50% reduction milestone set for 2025. 

Similarly, the coverage of rapid testing for TB, TB treatment, and TB preventive treatment, as well as funding for TB prevention, diagnosis, treatment services, and research, are all areas where significant gaps remain compared to the set targets.

Overall, while there are some positive trends and regional successes in combating TB, the global community still has a long way to go to end the TB epidemic. It requires continued efforts across multiple sectors, including enhanced diagnosis, treatment, prevention strategies, and increased funding for research and healthcare services.

4. Challenges in Global Tuberculosis Prevention and Control

Tuberculosis (TB) is a global health issue that demands urgent attention. According to the World Health Organization's (WHO) Global tuberculosis report 2024, TB has likely returned to being the world's leading infectious disease killer.

The report indicates that in 2023, approximately 10.8 million people (95% uncertainty interval [UI]: 10.1–11.7 million) fell ill with TB (incident cases). While this represents a continued increase from previous years, the rate of increase has slowed and started to stabilize. Geographically, the highest number of TB cases in 2023 were in the WHO regions of South-East Asia (45%), Africa (24%), and the Western Pacific (17%).

Drug-resistant TB remains a significant concern. Globally, the estimated annual number of people developing multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) was relatively stable between 2020 and 2023. However, five countries accounted for more than half of the global number of people estimated to have developed MDR/RR-TB in 2023: India (27%), the Russian Federation (7.4%), Indonesia (7.4%), China (7.3%), and the Philippines (7.2%).

In terms of TB deaths, the estimated global number fell for a second consecutive year in 2023, yet TB probably returned to being the world's leading cause of death from a single infectious agent following the decline of COVID-19. In 2023, TB caused an estimated 1.25 million deaths (95% UI: 1.13–1.37 million), including 1.09 million among HIV-negative people and 161,000 among people with HIV.

Progress towards the WHO End TB Strategy milestones and targets set for 2025 and 2027 has been mixed. For example, the net reduction in the TB incidence rate between 2015 and 2023 was 8.3%, far from the 50% reduction milestone by 2025. Coverage of rapid testing for TB, TB treatment, and TB preventive treatment also fall short of the set targets.

Diagnostic testing for TB shows that the use of WHO-recommended rapid diagnostic tests (WRD) as the initial test increased slightly in 2023 to 48% globally, but remains below the 100% target for 2027. Meanwhile, the global coverage of HIV testing among people diagnosed with TB remained high at 80% in 2023.

Overall, while there have been some positive trends and efforts in the global fight against TB, significant challenges remain. Adequate funding, improved access to diagnosis and treatment, and continued research for new tools and strategies are crucial to accelerate progress towards ending the TB epidemic.

5. Future Perspectives and Responses to Global Tuberculosis

Tuberculosis (TB) remains a significant global health challenge. According to the World Health Organization's Global tuberculosis report 2024, despite efforts over the years, the goal of ending the global TB epidemic by 2030 is still distant.

In 2023, TB likely returned to being the world's leading cause of death from a single infectious agent, surpassing COVID-19. Each year, over 10 million people continue to fall ill with TB, and the number has been rising since 2021. It is caused by the bacillus Mycobacterium tuberculosis, which spreads when infected individuals expel bacteria into the air, for example, through coughing. Approximately a quarter of the global population is estimated to have been infected with TB.

The risk of developing active TB disease is highest in the first 2 years after infection, around 5%, and then decreases. While about 90% of annual TB cases are in adults, with more cases among men than women, it can affect anyone regardless of age or sex. The disease typically impacts the lungs (pulmonary TB) but can also affect other body sites.

Without treatment, the death rate from TB is high, close to 50%. However, with the currently recommended WHO anti-TB drug regimens lasting 4–6 months, around 85% of TB patients can be cured. Shorter regimens of 1–6 months are available for treating TB infection. Universal health coverage (UHC) is crucial to ensure that all those in need of treatment for TB disease or infection can access it. Additionally, multisectoral action addressing determinants like poverty, undernutrition, HIV infection, smoking, and diabetes can help reduce the number of new infections, cases, and deaths.

Some countries have managed to reduce their TB burden to fewer than 10 cases and less than one death per 100,000 population annually. But to rapidly decrease the global number of TB cases and deaths to match these low-burden countries, research breakthroughs, such as a new vaccine, are essential.

Political commitment to ending the TB epidemic has increased in recent years. The UN has held two high-level meetings on TB, in 2018 and 2023. The political declaration from the 2023 meeting reaffirmed existing commitments and targets within the UN Sustainable Development Goals (SDGs) and the WHO End TB Strategy and introduced new ones for 2023–2027. These include targets related to TB treatment coverage, preventive treatment, rapid diagnostic testing, health and social benefits packages for TB patients, availability of new vaccines, and funding for TB prevention, diagnosis, treatment services, and research.

The WHO Global tuberculosis report 2024 is based primarily on data collected from national health ministries in annual data collection rounds. In 2024, 193 out of 215 countries and areas, representing over 99% of the world's population and TB cases, reported data. It also utilizes other databases like the WHO mortality database and those maintained by other UN agencies and the World Bank. 

Resource from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024