Tuberculosis (TB) is an ancient disease that continues to have a devastating impact across the world and is of particular concern this World TB Day – 24 March 2025. The World Health Organization (WHO) estimates that TB has once again become the world's leading cause of death post coronavirus from a single infectious agent, killing over one million people annually. TB is both preventable and curable, yet it disproportionately affects low- and middle-income countries (LMICs), where poverty and weak health systems limit access to care. In a moment where humanitarian funding is dwindling, the theme of World TB Day, Commit, Invest, Deliver, could not be more pertinent.
TB interventions often face challenges in LMICs, where limited infrastructure and unreliable resources create significant implementation gaps. While recent initiatives for community-based approaches have improved access, TB still demands lengthy treatment regimens to achieve full recovery. Disruptions in follow-up and continuity of care contribute to unsuccessful treatment and fuel the spread of multidrug-resistant TB (MDR-TB). MDR-TB treatment regimens are more complex, expensive, longer in duration, and associated with more severe side effects. In 2023, only 44 per cent of the 400,000 estimated MD-TB cases were diagnosed and treated, highlighting significant gaps in reaching patients and delivering effective care.
Médecins Sans Frontières (MSF) conducted and coordinated the TB PRACTECAL clinical trial, focused on developing and testing a safer, shorter, and more effective treatment regimen for MDR-TB. The results of the trial provided a practical, all-oral six-month treatment regimen, representing a significant improvement over the long, challenging, and less effective previous treatment. This regimen not only offers a promising solution for treating TB in resource-limited settings but underscores the importance of tailoring interventions to address the unique needs of underserved populations. Despite being recommended by the WHO as a first-line treatment for the past two years, it has yet to be adopted by several countries.
The surge of record-high conflicts since World War II creates conditions that significantly accelerate TB transmission. Protracted violence devastates healthcare system, exacerbates overcrowding, and heightens malnutrition— factors that collectively fuel the spread of this disease. Conflict-driven displacement disrupts continuity of care through instability, long travel distances, and financial insecurity. Malnutrition especially, increases susceptibility and worsens TB progression, creating a vicious bidirectional relationship. Malnourished children under five are at heightened risk of progressing from TB infection to severe forms such as miliary TB and meningitis, often resulting in death if left untreated. Nutritional support not only significantly reduces the risk of tuberculosis mortality but helps prevent development of disease among children with close TB exposure. However, with 75 per cent of the world’s stunted and wasted children living in conflict-affected areas, urgent research and interventions targeting children with TB and severe acute malnutrition are critical.
While the neonatal BCG vaccination offers protection against severe forms of TB in infants and young children, its effectiveness diminishes over time. Furthermore, the vaccine does not protect adolescents and adults, who account for most of TB transmission. Modelling suggests that a vaccine preventing more infectious forms of TB in these older age groups would make the most significant contribution to TB control. Achieving the WHO End TB Strategy target of a 95 per cent reduction in TB mortality worldwide by 2035, will require a new vaccine that is effective across all age groups.
However, this goal appears increasingly out of reach with the 2025 funding cuts severely impacting TB programmes, especially in LMICs that rely significantly on international aid. As demonstrated during the COVID-19 pandemic, disruption to essential TB services reversed years of progress, causing an excess of 700,000 deaths between 2020 and 2023. Intermittent or incomplete treatment is extremely dangerous as it increases the risk of drug resistance, prolongs the infection, and heightens the potential of transmission to others. Modelling suggests that USAID funding cuts could result in an estimated 10 million additional TB deaths and 12 million additional TB cases.
This World TB Day, it is more urgent than ever for the global community to advocate for and prioritise evidence-based action for underserved populations. Funding cuts and ongoing neglect is set to worsen TB’s already devastating impact. The progress made in tackling TB— from shorter, more effective treatment regimens to advances in paediatric care— is now at risk. Sustained investment and commitment into research, vaccines and accessible treatments are crucial to free the world of TB.