Catherine Hodge

Catherine Hodge

Tackling TB in the 21st century

31 March 2022

Doctor looking at a chest x-ray

Many people associate tuberculosis with the past, but it still poses a very real threat today. In 2022, World TB Day continues to call for concerted efforts to control TB.

It’s time to talk about tuberculosis, commonly known as TB. The bacterial infection was once called ‘the romantic disease’ due to its association with the deaths of artists, musicians, authors, poets and playwrights; John Keats, the Brontë sisters, Frederic Chopin, George Orwell and Anton Chekhov were all killed by TB.

A TB infection won’t necessarily make you ill. Mycobacterium tuberculosis (the bacteria that cause TB) can lie dormant in your body for years, kept at bay by your immune system. If this is the case, you will not have symptoms or be able to infect other people – this is known as latent TB. However, it can progress to active TB (also called TB disease) at a later date, especially if your immune system is weakened.

TB affects the most vulnerable people in society and continues to be resistant to control measures. Before the COVID-19 pandemic, TB was the leading cause of death due to infectious disease in the world.

While the attention of those in health policy circles has understandably shifted towards COVID-19 in the past two years, and towards non-communicable diseases in the long term, it’s vital that we don’t neglect the challenges posed by TB.

Before the COVID-19 pandemic, TB was the leading cause of death due to infectious disease in the world.


Renew global efforts to control TB

In 2015, the World Health Organization (WHO) launched its End TB Strategy targets. By 2020, the WHO aimed to:

  • lower the global incidence of TB by 20%
  • reduce the number of TB deaths by 35%
  • ensure that no families affected by TB faced catastrophic costs.

Unfortunately, these targets were not met: the global incidence only fell by 11%, while deaths from TB decreased by 9%. In addition, an average of 47% of people affected by TB continue to face costs that represent more than 20% of their household income.

The COVID-19 pandemic has led to a shortfall in the global funding of TB programmes, as well as fewer people being diagnosed with TB. In 2020, 1.5 million people died from TB, up from 1.4 million in 2019 – the first increase in TB deaths for more than a decade. On World TB Day 2022, the WHO called for greater investment in TB programmes.

Protect people with HIV

TB is one of the most common co-infections and the leading cause of death among people living with HIV. A person with an untreated latent TB infection is far more likely to develop active TB if they also have an HIV infection. Many people who have both latent TB and HIV infections can be effectively treated using antibiotics, but regular screening is needed to identify infections and begin treatment.

Address antimicrobial resistance

Antimicrobial resistance (when pathogens stop responding to previously effective medications) poses a serious threat to global health. It can occur over time if people do not have access to full courses of appropriate medications or when medications are not used correctly.

Unfortunately, the bacteria that cause TB have developed resistance to historically effective treatments, resulting in cases of multidrug-resistant TB – which requires longer, more expensive and more invasive treatment. The European Centre for Disease Prevention and Control states that the existence of drug-resistant TB poses a serious challenge to eliminating TB across Europe.

World Health Organisation poster with headline 'drug-resistant tuberculosis remains a public health crisis' and stating some key figures from the blog.

The bacteria that cause TB have developed resistance to historically effective treatments, resulting in cases of multidrug-resistant TB.


Highlight the risk of TB posed by humanitarian crises

Conflicts and disasters have catastrophic effects on people’s health; TB is one of many diseases that thrive when people are displaced and resources are scarce. Those who are undernourished are three times more likely to develop active TB, while people with HIV and other conditions that cause immunodeficiency may struggle to access the medication that usually protects them from infections.

Although international humanitarian law prohibits the targeting of healthcare facilities during war, this does not stop the destruction of hospitals. People fleeing their homes do not necessarily have time to take any prescribed medication with them, increasing their risk of developing drug-resistant infections or of undiagnosed and untreated latent TB becoming active. Both Ukraine and Afghanistan have high rates of multidrug-resistant TB, which are likely to increase if access to care is curtailed and living conditions deteriorate. Conflicts have many horrific and long-term consequences, but among them is the very real prospect of surges in active TB infections.

TB continues to pose a significant threat to people’s health in our changing and unstable world. Our attention can easily move from one acute crisis to another, following the arc of TV cameras, but we cannot afford to forget and ignore the challenges posed by TB – especially when the voices of those who will be worst affected are easily silenced. For all of these reasons, it is time to talk about TB.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.