Five countries, including India, account for over half the global burden from tuberculosis (TB), said the World Health Organization in its latest report, as TB overtakes Covid-19 as the leading infectious disease killer in 2023.

“With the disease disproportionately affecting people in 30 high-burden countries, India (26 percent), Indonesia (10 per cent), China (6.8 per cent), the Philippines (6.8 per cent) and Pakistan (6.3 per cent) together accounted for 56 per cent of the global TB burden,” said the Global Tuberculosis Report 2024. Of those who developed TB, 55 per cent were men, 33 per cent were women, and 12 per cent were children and young adolescents.  

This report comes even as India targets ending TB by 2025, five years ahead of the international target. The WHO global report, released on Tuesday, presented a picture of mixed progress, and persistent challenges, including “significant underfunding”.

An estimated 8.2 million people were newly diagnosed with TB in 2023 – the highest since WHO began global TB monitoring in 1995, it said. “This represents an increase from 7.5 million reported in 2022, placing TB again as the leading infectious disease killer in 2023, surpassing Covid-19,” it added.

The number of TB-related deaths decreased from 1.32 million in 2022 to 1.25 million in 2023, the report noted, adding, however, that the total number of people falling ill with TB rose slightly to an estimated 10.8 million in 2023.

“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,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

The report further pointed to the narrowing gap in 2023 between the estimated number of new TB cases and those reported, at 2.7 million - down from the pandemic levels of around 4 million in 2020 and 2021. This reflected national and global efforts to recover from Covid-related disruptions to TB services, it said.

Drug resistance and funding gaps

But multidrug-resistant TB remains a public health crisis. Treatment success rates for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) have reached 68 per cent. “But, of the 400,000 people estimated to have developed MDR/RR-TB, only 44 per cent were diagnosed and treated in 2023,” the WHO said.

The report also noted that financial resources for TB prevention and care decreased further in 2023, and remain far below target. “Globally, TB research remains severely underfunded with only one-fifth of the $5 billion annual target reached in 2022. This impedes the development of new TB diagnostics, drugs, and vaccines,” it said.  

“Low- and middle-income countries (LMICs), which bear 98 per cent of the TB burden, faced significant funding shortages. Only $5.7 billion of the $22 billion annual funding target was available in 2023, equivalent to only 26 percent of the global target.”

The total amount of international donor funding in LMICs has remained at around $ 1.1–1.2 billion per year for several years, it said, adding that the United States government remains the largest bilateral donor for TB. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) also contributes towards TB response, especially in LMICs, but “it remains insufficient to cover essential TB service needs,” the note said.