The global community faces a complex and mounting challenge in eradicating tuberculosis (TB), a historic disease that continues to claim millions of lives annually, prompting leading health organisations to call for a comprehensive overhaul of prevention and treatment strategies. Despite decades of effort, TB remains a major public health crisis, exacerbated by the rise of drug-resistant strains and inconsistent resource allocation across vulnerable populations worldwide. The persistence of TB demands immediate, coordinated action focused on improving early diagnosis, deploying innovative medication regiments, and addressing the social and economic determinants that fuel its spread.
The Lingering Shadow of a Curable Disease
Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, is both preventable and curable, yet it is currently the second leading infectious cause of death globally, surpassed only by COVID-19 at peak pandemic levels. The World Health Organization (WHO) estimates that millions of people fall ill with TB each year, with a significant proportion of these cases occurring in low and middle-income countries. Poverty, malnutrition, substandard housing, and inadequate access to healthcare services form a powerful nexus that sustains the infection cycle.
For too long, the global response has primarily relied on identifying and treating active cases, a strategy proving insufficient to halt transmission. Experts argue that a fundamental shift must occur toward proactive strategies that focus on preventing latent TB infection—where the bacteria is present but inactive—from progressing to active, transmissible disease.
Targeting Latent Infection and Drug Resistance
A major obstacle in the push for eradication is the sheer numbers of people living with latent TB—estimated to be nearly a quarter of the world’s population. Treating latent infection (often referred to as TB Preventive Treatment or TPT) is a highly effective intervention for individuals at high risk, particularly those who are immunocompromised or in close contact with active cases. However, TPT coverage remains low globally.
Furthermore, the emergence of drug-resistant TB (DR-TB) poses a severe threat. When patients do not complete their full course of treatment, or when drug quality is compromised, the bacteria can evolve resistance to standard medications. Multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) require longer, more toxic, and significantly more expensive treatment regimens, often yielding lower success rates.
“The fight against TB is inseparable from the push for universal healthcare access,” says Dr. Anya Sharma, Director of Global Infectious Disease Policy at the Centre for Disease Control in London. “We must dramatically reduce diagnosis times, integrate screening into primary care, and ensure sustained funding for research into shorter, safer, and more affordable drug combinations for DR-TB.”
Innovative Tools for a Renewed Commitment
The path forward requires investment in smarter, more accessible tools. Point-of-care diagnostic tests that can quickly detect TB and drug resistance—even in remote settings—are crucial. New, shorter treatment regimens (down from six months to four for drug-sensitive TB) are showing promise in improving patient adherence and reducing the risk of resistance.
Key action areas highlighted by international health bodies include:
- Scaling Up TPT: Making preventive treatment readily available and affordable for vulnerable groups.
- Enhancing Surveillance: Implementing better systems to track cases, patterns of drug resistance, and treatment outcomes.
- Social Protection: Addressing poverty and improving housing conditions to reduce the vulnerability of communities to infection.
- Vaccine Development: Prioritising the development of new, highly effective vaccines to replace the 100-year-old BCG vaccine, which offers limited protection against adult pulmonary TB.
The goal of ending the TB epidemic by 2030, a target set by the WHO, remains achievable but requires political will and a substantial increase in financial commitments from governments and donor nations. Without a renewed, multifaceted strategy that tackles both the microbe and the societal conditions that allow it to flourish, tuberculosis will continue to be a devastating force globally.
