World TB Day: Tuberculosis is on the rise globally – here's how we can end it for good

Tuberculosis (TB) kills – but it's an entirely curable and preventable disease that requires more funding.

In the past two decades, 66 million lives have been saved through diagnosis and treatment. Since 2019, though, some of the gains we've made globally towards eradicating this deadly disease have been lost.

In 2021, there were an estimated 1.6 million deaths due to TB globally, back up to the level of 2017 and reversing years of decline that started in 2005.

The World Health Organization (WHO) estimates that 10.6 million people became ill with TB in 2021 – a 4.5% increase on 2020 – while the incidence rate rose by 3.6% between 2020 and 2021, after declines of 2% per year for the previous two decades.

And the number of new diagnoses dropped from 7.1 million in 2019 to 5.8 million in 2020. In 2021, this was up to 6.4 million – but the lower numbers suggest there are rising numbers of people with untreated and undiagnosed TB.

Diagnosis and treatment resources were diverted towards managing the pandemic, as spending on TB services worldwide fell from $6 billion in 2019 to $5.4 billion in 2021.

This World Tuberculosis Day Day (24 March), the World Economic Forum is supporting the WHO and the larger community in fighting TB to get back those gains in progress and end the epidemic by 2030.

TB is an infectious disease affecting the lungs, caused by a bacteria called Mycobacterium tuberculosis. Unlike COVID-19, it's not a virus, but it's the second biggest infectious killer after COVID.

Its incidence varies significantly across regions, with more than 80% of cases and deaths occurring in low and middle-income countries. There are clearly social determinants to tuberculosis – it's the disease of the world's poor.

India has the highest burden of TB, with more than 2.5 million cases in 2021, around a quarter of the cases worldwide. In 2021, more than half a million people in India died from TB – around a third of the global deaths. The Indian government has set a very ambitious target to end TB by 2025 – five years ahead of the WHO goal.

Eight countries, including India, accounted for more than two-thirds of the global total of new TB cases in 2020 – Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo – while 30 high-TB burden countries had 87% of the new cases.

To complicate matters, there are two types of TB – latent and active – and there are drug-sensitive and drug-resistant forms of active TB.

Around 1.7 billion people – a quarter of the world's population – have latent TB, which means it's present in people's body system, but it doesn't necessarily turn into disease.

It's thought that 40% of people in India have latent TB, picking up the infection by breathing in air in proximity to people with active TB.

Latent TB can become active if your immune system is affected by another health condition, such as HIV or diabetes. In India, only 10% get TB disease.

Diagnosis of latent and active TB, treatment, and vaccination are three essentials to achieve the 2030 goal of ending TB. But the WHO's End TB Strategy also calls for "intensified research and innovation".

As WHO Director-General Tedros Adhanom Ghebreyesus said in the Global Tuberculosis Report 2022: "If the pandemic has taught us anything, it’s that with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threats. Let’s apply those lessons to tuberculosis. It is time to put a stop to this long-time killer."

Here's what the Forum and its partners are doing to aid this effort ...

There's still just one licensed vaccine for tuberculosis – BCG, which was first administered in 1921, more than 100 years ago. But it's only effective in children.

If we can have an effective TB vaccine especially in countries that have a heavy TB burden, that will go a long way to ending the disease, but we urgently need to speed up the development of vaccines. There are 16 TB vaccines in the R&D pipeline but developing them requires funding.

During a panel discussion organized by the World Economic Forum in Davos in January 2023, the Director General of the WHO, Dr Tedros, announced the establishment of a new TB Vaccine Accelerator Council to fund and facilitate the licensing and use of effective new TB vaccines.

Each vaccine takes several hundred million dollars to develop, and despite funding from philanthropic organizations, including the Wellcome Trust and the Bill & Melinda Gates Foundation, there's still a shortfall because of market forces.

One of the challenges is limited commercial opportunity for TB drugs and vaccines in developed countries which hinders R&D investment in this disease area.

But there is a strong economic argument for developing vaccines – besides the fact that they are able to save millions of lives. The WHO says that a vaccine with 50% efficacy at preventing disease in adolescents and adults could avert 8.5 million deaths, prevent 76 million new cases of TB – and save $6.5 billion for the households affected. At 75% efficacy, that rises to saving 12.3 million lives.

The study, An Investment Case for New Tuberculosis Vaccines, says that every $1 invested in the 50% effective vaccines could return $7 through saved healthcare costs and increased productivity.

We need to come up with financial models for TB vaccines development so that – even though the return on investment may not be as big as on COVID inoculations or other vaccines – it’s still a sustainable business which saves millions of lives.

The treatment we have for drug-sensitive TB is old, just like the vaccine – it hasn't changed in 40 years. It’s still a six-month regimen.

For Multidrug-Resistant TB, or MDR TB, it's a cocktail of drugs that are given together. You have to take them for 18 to 24 months, and they have very unpleasant side effects.

Innovative work is going on by Forum partners to create novel pan-TB drug regimens that will treat both drug-sensitive and drug-resistant TB with a shorter treatment duration.

At Davos in 2020, before COVID-19 was declared a pandemic, the Forum hosted the launch of Ending Workplace TB (EWTB), a network that supports companies in building stronger workplace health systems to tackle all respiratory diseases.

EWTB is a coalition of multinational companies dedicated to strengthening tuberculosis care and prevention in their workplaces, supply chains and communities. As of February 2023, the EWTB network has 50 members, including Johnson & Johnson, PwC, Accenture and Amazon, covering over 2 million employees.

EWTB focuses on impact in two ways:

Education around workplace TB includes the need for screening and diagnosis in low and middle-income countries where TB is more prevalent.

By working together, collaborating and innovating, we can put an end to TB.