The World Health Organization has released its latest “Global Tuberculosis Report 2024,” showing an alarming resurgence of tuberculosis (TB) as the world’s leading infectious disease killer, overtaking COVID-19. In 2023, TB infected 8.2 million people globally—the highest since WHO began tracking TB cases in 1995, marking an increase from 7.5 million cases in 2022. Despite a slight decrease in TB-related deaths, from 1.32 million in 2022 to 1.25 million in 2023, the rise in new cases highlights the ongoing challenges in combating TB.
Given that the tools to prevent, detect, and treat TB are readily available, the surge in TB incidence is a worrying trend for health systems worldwide. It emphasizes the need for nations to act on their commitments to eradicate TB, which remains concentrated in 30 high-burden countries. India, Indonesia, China, the Philippines, and Pakistan together accounted for 56% of global TB cases, with India alone shouldering 26%.
Persistent Challenges and Underfunding
The report notes significant funding gaps in TB prevention and care, particularly in low- and middle-income countries (LMICs), which bear 98% of the TB burden. In 2023, just USD 5.7 billion of the USD 22 billion annual target for TB prevention and treatment was met, which is only 26% of the funding required. Additionally, TB research remains severely underfunded, with only 20% of the targeted USD 5 billion for TB research and development reached in 2022. This lack of funding hampers efforts to innovate and scale up new diagnostics, drugs, and vaccines necessary to tackle TB effectively.
While global efforts have reduced the gap between estimated and reported TB cases, from around 4 million during the COVID-19 pandemic to 2.7 million in 2023, multidrug-resistant TB (MDR/RR-TB) remains a critical challenge. Treatment success rates for MDR/RR-TB are now at 68%, yet only 44% of the estimated 400,000 MDR/RR-TB cases were diagnosed and treated in 2023.
Socioeconomic and Health-Related Drivers
WHO’s report highlights how TB is intertwined with socioeconomic and health risk factors. Five major risk factors—undernutrition, HIV, alcohol use disorders, smoking, and diabetes—play a substantial role in driving new TB cases. Globally, half of TB-affected households face catastrophic costs, spending more than 20% of their income on TB diagnosis and treatment, placing immense financial strain on families.
Complicating the fight against TB are factors such as poverty, inadequate access to healthcare, climate change, migration, conflict, and displacement, all of which impact TB transmission. Drug-resistant TB is also contributing to a global antimicrobial resistance crisis, which is exacerbated by limited resources for effective intervention in many LMICs.
India’s Commitment to TB Elimination by 2025
India, which carries the world’s largest TB burden, has set a bold target to eliminate TB by 2025, five years ahead of the UN’s Sustainable Development Goals (SDG) 2030 deadline. With 26% of the global TB burden, India has mobilized a multi-sectoral approach to fight TB, focusing on early detection, comprehensive treatment, and preventive care.
India’s National TB Elimination Programme (NTEP) aims for early diagnosis and quality-assured treatment, engaging private health providers and enhancing community-based prevention. Key strategies include contact tracing, airborne infection control, and addressing socioeconomic factors that contribute to TB transmission.
Launched in 2022, the Pradhan Mantri TB Mukt Bharat Abhiyaan drives community engagement in a “Jan Andolan” (people’s movement) against TB. Through the Ni-kshay Mitras initiative, volunteers provide nutritional, financial, and vocational support to TB patients, aiming to reduce the stigma associated with the disease and enhance recovery rates. As of April 2024, over 155,000 Ni-kshay Mitras had enrolled, with more than 866,000 patients opting for community support.
India has amplified active case finding efforts among high-risk groups, detecting an additional 300,000 TB cases. The government’s Viksit Bharat Sankalp Yatra health camps screened over 38 million people for TB in 2023 alone, leading to over a million referrals for testing. India’s decentralized Ayushman Bharat Arogya Kendras have been instrumental in TB case notifications, which rose to 2.55 million in 2023, exceeding pre-COVID levels.
India’s targeted engagement with the private sector has significantly boosted TB case notifications, with private health providers now reporting 33% of all cases nationwide. The Patient Provider Support Agency (PPSA) program and partnerships with organizations like the Indian Medical Association (IMA) have helped increase private sector case notifications by eight times over the last nine years. Treatment success rates have held steady at 86.9%, bolstered by shorter, safer oral regimens for drug-resistant TB.
Undernutrition is a critical risk factor for TB, and India’s Ni-kshay Poshan Yojana addresses this by providing direct financial support to TB patients to meet their nutritional needs. Since its launch in 2018, the program has disbursed over INR 2,859 crore to more than 10 million patients, significantly enhancing recovery outcomes.
India has expanded TB laboratory services over the past decade, with 24,449 microscopy centers and 6,196 molecular diagnostic labs now operational. The number of drug-resistant TB treatment centers has risen to 792, reflecting India’s commitment to scaling up infrastructure for TB control.
India’s comprehensive community-led approach to TB elimination, including the TB Mukt Panchayat Abhiyaan, empowers local councils to lead TB eradication efforts. The “TB-free Panchayats” initiative, for example, mobilizes rural communities to support detection, treatment, and prevention, reinforcing India’s position as a global leader in TB management. India’s efforts have been recognized by WHO, which commends the country’s success in reducing incidence and mortality at nearly double the global average reduction rate.
Focus During India’s G20 Presidency:India’s commitment to TB eradication extended to its G20 presidency in 2023, where it advocated for digital health solutions, pharmaceutical manufacturing cooperation, and antimicrobial resistance. These priorities were highlighted in the Health Working Groups and Ministerial Meeting, underscoring India’s role in championing TB elimination globally.
Moving Forward: Sustaining the Fight Against TB
With less than two years to meet its 2025 target, India remains committed to fighting TB through strong government action and community support. As part of the G20 presidency in 2023, India emphasized TB eradication, digital health innovation, and antimicrobial resistance. WHO’s multi-sectoral accountability framework for TB calls for broader engagement, urging countries to translate high-level commitments into tangible actions to meet global targets and reduce the devastating impact of TB worldwide.
References:
Tuberculosis Resurges as Leading Infectious Disease Killer – WHO News Release, 29 October 2024
Tuberculosis: Current Situation, Challenges, and Future Perspectives – Journal of Global Infectious Diseases
WHO Global Report: TB Overtakes Covid-19 as Leading Infectious Disease Killer – The Hindu Business Line
TB Infects Around 8 Mn People in 2023, Highest Ever Seen, Says WHO – Business Standard
India Committed to Becoming Free of TB by 2025, Working on Mission Mode – Business Standard
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