World TB Day: Here's how we can end tuberculosis for good

This article was first published in March 2023 and was updated in March 2024.

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

Since 2000, an estimated 75 million lives have been saved by global efforts to combat TB, but, in 2022 alone, 7.5 million people were newly diagnosed with the disease and, after COVID-19, it was the second leading cause of death from a single infectious agent.

An estimated 1.3 million people died due to TB in 2022, according to the World Health Organization (WHO), while it's estimated that 10.6 million people developed TB (a gap of 3.1 million more than were diagnosed) up from 10.3 million in 2021.

Global targets to end TB are off track, but more funding on diagnosis, prevention and treatment can accelerate progress towards eradicating the disease.

The WHO's End TB Strategy has set a target of a 90% in the global number of deaths by 2030. Between 2015 and 2022 the net reduction was 19%.

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

In 2022, that figure rose to $5.8 billion - still below pre-COVID levels and less than half of the target of at least $13 billion per year by 2022.

TB research averaged just under $1 billion per year in 2022, reports the WHO, less than half of the $2 billion target.

The WHO's newly published Investment Case for Screening and Preventative Treatment finds that every dollar invested in screening and preventative treatment could generate a return of up to $39. It was based on research in South Africa, Brazil, Georgia and Kenya.

In September 2023, world leaders gathered at the United Nations General Assembly’s High-Level Meeting on Tuberculosis to approve a Political Declaration to advance the global efforts towards ending TB.

Targets include reaching 90% of people with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB; providing social benefit packages to all people with TB; licensing at least one new TB vaccine; and closing funding gaps for TB implementation and research by 2027.

This World Tuberculosis Day Day (24 March), the World Economic Forum is supporting the WHO and the larger community in fighting TB to turn those targets into actions 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.

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 at the United Nations General Assembly’s High-Level Meeting on TB: “For millennia, our ancestors have suffered and died with tuberculosis, without knowing what it was, what caused it, or how to stop it.

“Today, we have knowledge and tools they could only have dreamed of. The political declaration countries approved today, and the targets they have set, are a commitment to use those tools, and develop new ones, to write the final chapter in the story of TB.”

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.