The persistent threat of tuberculosis − Why ending TB remains elusive?

Despite significant advancements in medical science and public health initiatives, tuberculosis (TB) remains one of the leading causes of death from infectious diseases worldwide. The World Health Organization (WHO) recently reported that TB has surged back to the forefront, surpassing COVID-19 as the top infectious disease killer in 2023. With approximately 8.2 million new cases diagnosed, the urgency to confront this persistent threat has never been greater [1].

TB has plagued humanity for centuries, and despite the availability of effective treatments, it continues to claim lives at an alarming rate. The WHO's Global Tuberculosis Report 2024 highlights that while TB-related deaths decreased slightly from 1.32 million in 2022 to 1.25 million in 2023, the total number of individuals falling ill with TB rose to an estimated 10.8 million. This paradox emphasizes the complexities involved in eradicating a disease that is both preventable and treatable [1], [2].

Historically, global efforts to control TB have been hampered by a lack of funding, inadequate healthcare infrastructure, and social determinants such as poverty and malnutrition. The WHO estimates that about 50 % of households affected by TB face catastrophic costs defined as expenditures exceeding 20 % of their annual income – when seeking diagnosis and treatment. This financial burden not only deters individuals from accessing care but also perpetuates cycles of poverty and illness [1], [3]. The burden of TB is disproportionately shouldered by low- and middle-income countries (LMICs), which account for 98 % of global cases. Notably, five countries—India, Indonesia, China, the Philippines, and Pakistan – together represent 56 % of the global TB burden [1], [3].

The resurgence of TB can be attributed to several interrelated factors. First, the COVID-19 pandemic disrupted essential TB services worldwide, leading to a significant decline in diagnoses and treatments. As healthcare systems struggled to cope with the pandemic's demands, TB services were deprioritized, resulting in an estimated 2.7 million gap between new cases and those reported in 2023 [1]. Furthermore, multidrug-resistant tuberculosis (MDR-TB) poses a formidable challenge. The WHO estimates that approximately 400,000 individuals developed MDR-TB in 2022; however, only 44 % were diagnosed and treated. The lack of effective treatment options for MDR-TB exacerbates the crisis, making it imperative to invest in research and development for new drugs and treatment regimens [1], [4].

Addressing TB requires a comprehensive understanding of its social determinants. Factors such as undernutrition, HIV infection, alcohol use disorders, smoking, and diabetes significantly contribute to the incidence of TB. Tackling these issues necessitates coordinated multisectoral action that goes beyond traditional healthcare responses to address the root causes of health disparities [1], [5]. For instance, improving nutrition and access to healthcare can substantially reduce the risk of developing active TB among those infected with Mycobacterium tuberculosis. Moreover, integrating TB services with HIV treatment programs can enhance outcomes for co-infected individuals, who are at a higher risk for severe disease [3]. A critical barrier to ending TB is the significant funding shortfall for prevention and treatment programs. In 2023, only $5.7 billion was allocated for TB services – less than half of the required $13 billion target set by WHO member states. This underfunding severely limits the ability to implement effective interventions and scale up services where they are most needed [1], [3].

The WHO report highlights that the current global targets, including those set for 2027, are unlikely to be met without substantial interventions [1]. The setbacks underscore a need for renewed international collaboration and political commitment to TB control, not only to meet eradication milestones but to address this significant public health threat as a matter of moral and social responsibility. Increased investment, expanded diagnostic capacity, and a coordinated focus on treatment access and affordability in low-resource settings will be essential to reducing TB’s toll on the world’s most vulnerable populations [1], [3]. With effective and equitable global action, TB eradication goals could be brought within reach. However, achieving this requires a paradigm shift in how the world views and funds the fight against TB. The WHO has called for urgent action from governments and international organizations to fulfill their commitments to combat TB effectively. Without adequate resources, achieving global targets for reducing the burden of TB will remain elusive [1], [4]. Ending the global TB epidemic is not merely a health imperative; it is a moral obligation. The existing tools like effective diagnostics, treatments, and preventive measures must be deployed equitably and effectively across all populations at risk. It is essential that countries prioritize TB within their public health agendas and mobilize resources to ensure universal access to care.

In conclusion, while the challenges posed by tuberculosis are alarming, they are not invincible. By addressing funding gaps, enhancing healthcare infrastructure, tackling social determinants of health, and fostering international collaboration, we can make significant strides toward ending this persistent threat once and for all. The time for action is now; we cannot afford to let history repeat itself as we strive for a future free from tuberculosis.

Declaration of Generative AI and AI-assisted technologies in the writing process

No AI/AI tools were used while working on this manuscript.

CRediT authorship contribution statement

Tarun Kumar Suvvari: Conceptualization, Data curation, Formal analysis, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing.

Funding

No funding received.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.