GLOBAL TB REPORT
SPECIAL UPDATE
This is a special update for Global TB Caucus members. The World Health Organization's Global TB Report was launched late last month with new estimates on the global TB burden. This update includes the headline data and specific information on molecular diagnostics.
WHO GLOBAL TUBERCULOSIS REPORT
October 2024
10.8 million - Total number of people estimated to have fallen ill with TB in 2023
8.2 million - People who were formally diagnosed with TB and notified
1.25 million - People who are estimated to have died from TB in 2023
Every year, the World Health Organization (WHO) publishes a report that summarises the epidemiology of the TB crisis and the public health response mounted by governments around the world. Presenting new data from January to December 2023, this report offers an important insight into the trajectory of the TB epidemic and response following the acute disruption of COVID-19 in 2020 and 2021.
The message is clear: while countries made progress in recovering from the pandemic, efforts are falling woefully short of what is needed to deliver the targets set out in the WHO End TB Strategy or agreed by governments at the United Nations High-Level Meetings on TB in 2018 and 2023. .
As we near the end of 2024, it is clear that parliamentary action is urgently needed to ensure that TB services have the resources to get back on track.
Key data points
Incidence
The total number of people falling ill with TB each year has stabilised at 10.8 million, following several years of increased incidence due to COVID-19 service disruptions. South Africa is the only high TB burden country to have reached the 2025 target of a 50% reduction in TB incidence since 2015. Kenya, United Republic of Tanzania and Zambia are nearing this milestone.
Deaths
The total number of people who died fromTB decreased in 2023 to 1.25 million. This is below the pre-pandemic level of 1.34 million deaths, representing only a 23% reduction in mortality since 2015 compared to a target of 35% by 2020 and 75% by 2025.
Case finding
The total number of people diagnosed with TB and notified reached a new record of 8.2 million. While this is good news, this number likely includes a significant backlog of people who fell ill during the pandemic but did not reach services until 2023. The biggest contributors to this rebound were India, Indonesia, the Philippines, Nigeria and Pakistan. A small number of high TB burden countries have not returned to pre-pandemic levels of case finding: Angola, Lesotho, Liberia, Mongolia, Myanmar, Thailand and Zimbabwe.
Access to diagnosis
Only 48% of people with TB were diagnosed using a WHO-recommended rapid diagnostic (WRD, e.g. GeneXpert) as their first test. This is a minimal improvement on the 47% reported in 2022 and compares to a new global target of 90% of cases being diagnosed with a WRD. WRDs are critical to speeding up diagnosis and ensuring more people, particularly those with drug-resistant TB, access the right treatment.
Treatment coverage
Global treatment coverage is estimated at 75%. A number of high TB burden countries have reported treatment coverage over 80%, including Brazil, India, Mozambique, Papua New Guinea, Sierra Leone, Uganda and Zambia, though both Mozambique and Papua New Guinea have very low levels of bacteriological confirmation and may therefore have a higher rate of false diagnosis and treatment enrollment. Lesotho, Liberia, Mongolia and Myanmar all reported treatment coverage below 50%, while the greatest number of people missing out on treatment can be found in India (16%), Indonesia (11.5%), Pakistan (7.8%), China (6.5%) and Myanmar (6.5%).
AMR
Among people with a bacteriologically confirmed TB diagnosis, 79% were tested for resistance to rifampicin, the most effective and widely used anti-TB medicine. While the total number of people with rifampicin- or multidrug-resistant TB has stabilised around 400,000, only 44% of these were able to access diagnosis and treatment. The largest gaps were reported in India, Philippines, Indonesia, China, Pakistan, Myanmar, Ukraine, Nigeria, Viet Nam and South Africa.
Preventive treatment
People who have been infected with the TB bacterium can be offered TB preventive treatment (TPT) to prevent the infection from developing into symptomatic and infectious TB disease. In 2023, 4.7 million people were able to access TPT, which represents a significant increase from both 2022 and pre-pandemic levels. Much of this increase was driven by greater access to TPT among adult household contacts of people with confirmed TB disease.
Funding
Funding for TB programmes has dropped below USD 6 billion for the first time in 5 years. While much of this decline is explained by reduced domestic financing in Brazil, Russian Federation, India, China and South Africa (BRICS), financing continues to fall dramatically short of the target of USD 22 billion per year agreed by governments at the United Nations High-Level Meeting on TB. International financing has remained stable for a number of years now, at between USD 1.1 and 1.2 billion per year.
Next steps
The Global TB Caucus Secretariat will develop country-specific briefings using the new WHO data in the coming weeks. If you are interested in a particular policy area, please let us know and we will provide a personalised briefing.
Too little progress on rapid molecular diagnostics, according to WHO
WHO-recommended rapid diagnostic tests (WRDs), such as GeneXpert MTB/RIF, transformed the diagnosis of people with TB because they can bacteriologically confirm the diagnosis and assess resistance for common TB medicines within a matter of hours. Prior to their introduction, it would have taken weeks to produce the same results.
When world leaders met at the 2023 United Nations High-Level Meeting on TB, they committed to at least 90% of people estimated to fall ill with tuberculosis being reached by quality diagnosis and treatment by 2027, with 100% of people being diagnosed with a WRD.
The new WHO Global TB Report, shows a new record number of people with TB were diagnosed. However, while the total number of WRD tests that were conducted has increased, the proportion of newly diagnosed people who were initially tested with a WRD has fallen, suggesting that the scale up of WRD's is not keeping pace with demand. As a result, only 48% of people diagnosed and reported as having TB in 2023 were first tested with a WRD, highlighting the need for a step change to deliver on UN High-Level Meeting goals across most regions:
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Africa: There has been a gradual improvement in the proportion of newly notified TB cases that were diagnosed using a WRD across the Africa region, from 36% in 2020 to 54% in 2023. A number of African countries reported that over 80% of people diagnosed with TB were initially tested with a WRD in 2023, including Gabon, Mozambique, Namibia, South Africa and Zambia. However, many people on the African continent are at risk of being left behind, with performance below the regional average in many high TB burden countries, including Angola (1.8%), Central African Republic (33%), Congo (41%), Democratic Republic of Congo (14%), Ethiopia (30%), Kenya (54%), and Liberia (33%).
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Americas: Across the Americas region, 47% of people diagnosed with TB in 2023 were first tested with a WRD. Only 2 countries in the region are included in the WHO list of high TB burden countries. In Brazil, 50% of people diagnosed with TB were initially tested with a WRD. In Peru, a high MDR-TB burden country, 31% of people diagnosed and notified with TB were tested using a WRD. In both countries, this represents a gradual improvement, but progress will need to be significantly accelerated to meet the UN High-Level Meeting targets.
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Asia Pacific: The proportion of newly diagnosed people being tested with WRD is lowest in the Southeast Asia Region (39%), and while significant progress has been made in the Western Pacific region over the last decade, the most recent data suggests this has flatlined (64%). Some high TB burden countries have been able to sustain gradual increases in the proportion of cases tested with WRDs, including China and Thailand. In other countries, the trend has flatlined or reversed. In some cases, this is because WRD access has not kept pace with increased case finding. Pakistan, for example, diagnosed and notified more than 50,000 additional TB cases in 2023 than 2022, but only 48% of these were diagnosed using a WRD, compared to 63% in 2022.
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Eastern Europe and Central Asia: High TB burden countries in the European Region of the WHO have been able to maintain good access to WRDs as the first diagnostic test for TB. While 78% of people diagnosed across the whole region are first tested using a WRD, this proportion is higher in countries with a high burden of TB, including Azerbaijan (100%), Belarus (93%), Kazakhstan (99%), Kyrgyzstan (90%), Republic of Moldova (94%), Tajikistan (88%), Ukraine (96%) and Uzbekistan (100%).
