Dear Editor,
As World Tuberculosis (TB) Day on March 24 approaches, the recently published 2024 WHO Global Tuberculosis Report provides critical insights into the ongoing challenges and opportunities in the fight against TB [1]. Despite global efforts, TB remains the second leading infectious cause of mortality, underscoring persistent gaps in diagnosis, treatment, and prevention strategies. In this manuscript, we discuss the 2024 WHO Global TB Report, focusing on the global TB burden, major challenges in combating the disease, and essential policy recommendations for advancing eradication efforts.
1. The global burden of TB: Alarming Trends and Emerging threats
According to the 2024 WHO report, an estimated 10.8 million new TB cases and 1.25 million deaths occurred worldwide in the past year. While global TB incidence has declined in the past decade, progress remains uneven, with several high-burden countries still reporting alarming case rates. Socioeconomic inequalities, population displacement due to conflicts, and disruptions in healthcare services from pandemics and natural disasters continue to drive the sustained transmission of TB in vulnerable populations [2].
Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) remain major global health threats, with recent data indicating that approximately 400,000 of all new TB cases and 150,000 deaths in 2023 [1]. Low-income countries bear a disproportionate burden of drug-resistant TB, often lacking the laboratory infrastructure to rapidly detect resistance and provide timely, effective treatment. The success rate for MDR-TB treatment remains below 60 % in many resource-limited settings, largely due to delayed diagnosis, inadequate drug supply, and patient non-adherence caused by prolonged treatment regimens and high toxicity of older drugs [3].
2. Challenges in TB Diagnosis, Treatment, and prevention in Low-Income countries
One of the most pressing issues highlighted in the report is the ongoing diagnostic gap, which is particularly severe in low-income countries. Despite the availability of rapid molecular diagnostics such as GeneXpert MTB/RIF, many TB-endemic regions still rely on outdated smear microscopy, which has low sensitivity, particularly in pediatric and extrapulmonary TB cases. The high cost of newer diagnostic tools and the need for stable electricity and trained personnel further limit their widespread implementation [4]. Additionally, the integration of TB screening with other infectious disease programs, such as HIV/AIDS and COVID-19, remains inadequate [3,4]. Delayed diagnosis not only prolongs disease transmission but also leads to poorer patient outcomes..
Treatment-related challenges are exacerbated in low-income settings, where healthcare infrastructure and access to essential TB medications remain limited. While the rollout of all-oral regimens such as bedaquiline and pretomanid-containing treatments has improved outcomes, access disparities persist. Many patients in low-resource settings still receive older, toxic injectable drugs with prolonged treatment durations and severe side effects [5]. Furthermore, inconsistent drug supply chains and financial barriers prevent many patients from completing therapy, contributing to further development of drug resistance.
In terms of prevention, the TB vaccine pipeline is promising but requires accelerated research and funding. The BCG vaccine, while effective in preventing severe TB in children, provides limited protection against pulmonary TB in adults. Novel vaccine candidates, such as M72/AS01E, have demonstrated encouraging efficacy in phase 2 trials, but further clinical validation and global implementation strategies are needed. Additionally, the scale-up of preventive therapy with rifapentine-based regimens remains insufficient in many high-burden settings, where latent TB infection continues to serve as a significant reservoir for new active cases. Limited funding and logistical constraints have hampered the effective delivery of preventive therapy in TB-endemic regions, making this a critical area for future investment.
3. Policy recommendations and the Way Forward
To achieve the WHO End TB Strategy targets and move closer to TB eradication, a comprehensive, multi-sectoral approach is required. First, increased investment in TB research and development is paramount, particularly in diagnostics, shorter and more tolerable treatment regimens, and vaccine innovation. Second, health systems must be strengthened to ensure universal access to quality TB care, including decentralized diagnostic services, digital health solutions for patient monitoring, and integrated care for co-infections such as HIV and diabetes. Third, addressing social determinants of TB, such as malnutrition, overcrowding, and poverty, must be prioritized through intersectoral collaboration.
At the policy level, global and national TB programs must receive sustained financial commitment, with emphasis on equitable resource allocation and health system resilience [6]. Special focus should be placed on low-income countries, where additional funding and technical support from international agencies are urgently needed. The success of TB elimination efforts will depend not only on scientific advancements but also on strong political will, international partnerships, and community engagement. As we mark World TB Day, it is crucial to reinforce the global commitment to ending TB as a public health threat.
CRediT authorship contribution statement
Fatemeh Estaji: Writing – review & editing, Writing – original draft. Ali Kamali: Writing – review & editing, Writing – original draft. Masoud Keikha: Writing – review & editing, Writing – original draft, Supervision, Conceptualization.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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.
References
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