Monrovia — Tuberculosis was the leading killer among infectious diseases in 2023, the World Health Organization said. While the number of TB-related deaths decreased from 1.32 million in 2022 to 1.25 million in 2023, the UN agency says the total number of people falling ill with TB "rose slightly to an estimated 10.8 million in 2023", more than 8 million of which are newly affected.
This is the highest number recorded since WHO began its global TB monitoring in 1995.
In the organization's Global Tuberculosis Report 2024, WHO said 55% of people who developed TB were men, 33% women, and the remainder, were children. "The fact that TB still kills and sickens so many people is an outrage when we have the tools to prevent it, detect it, and treat it," WHO's Director General, Dr Tedros Adhanom, said.
Tedros urged countries around the world to make good on their commitments to "expand the use of those tools, and to end TB".
Africa is, however, cited as one of the regions of the world that has made the most progress in the fight against the disease, with a 24% decrease in cases. As the "net reduction" in the global deaths caused by TB between 2015 and 2023 was 23% globally - "almost one-third of the way to the agency's End TB Strategy milestone of a 75% reduction by 2025" - the African region made significant progress towards the attainment of this goal, with a 42% reduction.
Eight countries account for two-thirds of the global TB burden: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of Congo, while most of the global milestones and targets for reducing the TB burden by 2027 are off track.
"In contrast to the other five regions, the TB incidence rate in the WHO African Region has declined every year since 2010. Disruptions to TB diagnosis and treatment during the COVID-19 pandemic were negligible in the WHO African Region. In some countries, treatment coverage improved in these years," the report said.
However, 80% of the global number of deaths caused by TB among HIV-negative people occurred in the WHO African and South-East Asia regions, while WHO African and South-East Asia regions also accounted for 81% of the combined total number of deaths caused by TB among people with and without HIV.
The report describes the progress in reducing the TB rate in countries as "highly variable".
"By 2023, a total of 79 countries, mostly in the WHO African and European regions, had achieved estimated reductions of more than 20% since 2015, thus surpassing the first milestone of the End TB Strategy. A total of 13 countries are estimated to have achieved reductions of at least 50%. This includes one high TB burden country (South Africa). Three other high TB burden countries are estimated to be close to reaching the 2025 milestone: Kenya, the United Republic of Tanzania, and Zambia," the report revealed.
Earlier this year, the World Health Organization reported that the TB detection rate in Africa increased since 2018, with a further increase witnessed between 2020 and 2022, "rising from 60% to 70% of cases being detected". This is attributed to concerted efforts by countries in the region to address the threat posed by the disease.
The 2024 report states that the gap between the estimated number of new TB cases globally and those reported had narrowed to about 2.7 million in 2023, which followed "substantial efforts to recover from the COVID- related disruptions in TB services".
"It is striking that in the WHO African Region, TB case notifications increased throughout the pandemic and its aftermath; the total in 2023 was 34% above the level of 2019. This suggests that any COVID-related disruptions had no or limited impact on TB case detection. By 2023, TB case notifications in most of the 30 high TB burden and three global TB watchlist countries had recovered to the pre-COVID level or beyond. The exceptions were Angola, Lesotho, Liberia, Mongolia, Myanmar, Thailand and Zimbabwe," according to the report.
In 2023, South Africa was one of 10 countries that made up about 75% of the difference between the estimated number of people who got MDR/RR-TB and those who started treatment for it. To help close this gap, these countries need to improve how many people are tested for drug resistance and how easily they can access treatment, the WHO report advised.
RR-TB stands for rifampicin-resistant tuberculosis, a type of TB caused by bacteria that don't respond to rifampicin, a strong TB medicine. It's often grouped with multidrug-resistant TB (MDR-TB), which resists rifampicin and isoniazid. Both RR-TB and MDR-TB are difficult and expensive to treat.
The treatment usually involves second-line drugs like bedaquiline and fluoroquinolones, which can cost more and have more side effects than the standard treatments. Treatment can last months or years and might need to be closely monitored.
The financial burden faced by people with TB and their households was also cited as a major "barrier" to closing diagnostic and treatment gaps.
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"About 50% face total costs (direct medical expenditures, nonmedical expenditures, and indirect costs such as income losses) during diagnosis and treatment that are catastrophic. This is far above the WHO End TB Strategy target of zero. Reducing this burden requires faster progress towards UHC and better levels of social protection," the report said.
WHO's report referenced the drop in funding for TB - particularly from local sources. From 2019 to 2023, funding from local sources dropped by $1.2 billion, while funding from international donors increased slightly by $0.1 billion. Most of the drop in local funding came from trends in Brazil, Russia, India, China, and South Africa (BRICS), the report said.
The WHO called for "substantial increases" in domestic and international funding for TB, which are "urgently needed".
New TB cases are said to be driven by several risk factors, including undernutrition, HIV infection, and alcohol use disorders. "Tackling these issues, along with critical determinants like poverty and GDP per capita, requires coordinated multiculturalism action", according to the report, while urgently calling for more funding to address the "development of new TB diagnostics, drugs, and vaccines".
Edited by Juanita Williams
