Mycobacterium tuberculosis drug susceptibility test. Credit: CDC

By Alemnew Dagnew
WASHINGTON DC, Mar 20 2026 (IPS)

In many high-income countries, even a small number of tuberculosis (TB) diagnoses can generate headlines and prompt a rapid public health response. Recent situations in U.S. cities such as Seattle and San Francisco illustrate this, where media coverage has focused on the number of children being tested after TB disease was identified in a school.

In sub-Saharan Africa, these situations are viewed through a different lens. While some regions experience relatively low levels of TB disease, others face substantial challenges. Several countries in East and Southern Africa—including Ethiopia, Kenya, Uganda, Nigeria, and South Africa—remain among the high TB-burden settings globally, with significant variation in drug-resistant TB across and within countries.

In many of these settings, sustained transmission places continuous demands on health systems, requiring responses focused on large-scale, ongoing disease control rather than isolated events.

An estimated 10.7 million people globally fell ill with TB in 2024, and the disease killed 1.23 million, more than any other infectious disease. It is the leading killer of people living with HIV, and a major cause of deaths related to drug resistance. TB is a known risk in many parts of the world, yet in the U.S. it is relatively rare and is often perceived by the public as a disease of the past.

Our risk of exposure should not depend on something as haphazard as where we are born.

An estimated 10.7 million people globally fell ill with TB in 2024, and the disease killed 1.23 million, more than any other infectious disease. It is the leading killer of people living with HIV, and a major cause of deaths related to drug resistance. TB is a known risk in many parts of the world, yet in the U.S. it is relatively rare and is often perceived by the public as a disease of the past

This is the imperative that informs my work as a scientist endeavoring to develop a vaccine for TB. We want to bring locations with a high burden of either drug-resistant or drug-sensitive TB to a point resembling that of San Francisco or Seattle—where the disease is so rare that even a small number of diagnoses is an exceptional event.

TB is often described as a disease strongly associated with poverty. Transmission is facilitated in settings with poor ventilation and close contact, such as underground mines, crowded workplaces, and densely populated urban settlements.

Undernutrition—commonly linked to poverty—weakens immune defenses and increases the risk of developing TB disease. The illness can also place a heavy financial burden on households when the primary wage earner becomes sick, further compounding economic hardship and vulnerability.

Ethiopia is a high TB-burden country, and I witnessed the impact of the disease firsthand while living in the community and through my work as a physician and researcher there. I saw how TB affects families and communities, and it struck me deeply as the disease devastated many lives around me. This perspective has motivated me throughout my career.

The only current TB vaccine, the BCG vaccine, is an important but imperfect hundred-year-old tool. A review of studies on BCG concluded that while it provides protection to young children from severe forms of TB, it provides limited protection against pulmonary TB in adolescents or adults.

Adolescents and adults bear the greatest burden of pulmonary TB and are the primary drivers of transmission. Preventing TB in these age groups could therefore help protect people of all ages.

Widespread use of an effective TB vaccine could also contribute to reducing drug-resistant TB. By lowering the incidence of TB disease, it would reduce the need for antibiotic treatment—a critical step in curbing antimicrobial resistance.

The World Health Organization estimates that over a 25-year time span, a vaccine with 50% efficacy for protecting adolescents and adults could save 8.5 million lives, prevent 76 million new TB cases and save $41.5 billion for TB affected households.

A new vaccine, if able to deliver on this goal, could be game changing. But it will only have an impact if it is used by the people who would benefit most from it. The experience of the measles vaccine illustrates this point well.

Introduced more than 60 years ago, its success has depended on sustained efforts to ensure widespread use. Today, measles outbreaks still make headlines, but they are small compared with the devastating epidemics seen before vaccination. Over the past 25 years alone, measles vaccination is estimated to have prevented about 59 million deaths.

The TB vaccine candidate that we at the Gates Medical Research Institute are evaluating is among several candidates currently in late phase clinical trials. There has never been a time when the TB vaccine pipeline has shown such promise, bringing us closer than ever to improving the prospects for communities most affected by this disease.

If one of these vaccine candidates proves to be effective, it will be essential for governments, global health organizations, and communities to work together to ensure that it reaches those who would benefit most. Broad and equitable access will be critical to reducing the global burden of TB and moving closer to the goal of a world free of TB.

Alemnew Dagnew, M.D., is Head of Vaccines & Biologics Development at the Gates Medical Research Institute (Gates MRI), where he leads the clinical development of the M72 tuberculosis vaccine. Alemnew holds an M.D. and M.Sc. in Medical Microbiology from Addis Ababa University. He also earned an M.Sc. in Vaccinology and Pharmaceutical Clinical Development through a joint program from Novartis Vaccines and the University of Siena, and an MPH with a focus on epidemiologic and biostatistical methods from the Johns Hopkins Bloomberg School of Public Health.

A TB patient at the Srinagar-based Chest Diseases Hospital in the Indian state of Kashmir. Credit: Athar Parvaiz/IPS

By External Source
Williamsburg, VA, USA, Mar 21 2025 (IPS)

Tuberculosis (TB), caused by the aerophilic intracellular obligate pathogen Mycobacterium tuberculosis, is a globally endemic bacterial infection transmitted person-to-person through airborne droplets. Although fully preventable and curable, TB remains a persistent global health challenge and is projected to be a leading infectious disease by 2025.

Since its discovery in 1882, TB has claimed over one billion lives, continuing to be a deadly threat worldwide. While TB has been overshadowed by recent health crises such as COVID-19, it continues to be a leading cause of death in low- and middle-income countries (LMICs).

While it's unclear yet if global TB funding will eventually be restored, this disruption could reverse years of progress, increase mortality rates, and cause a resurgence of TB in vulnerable populations across the world

Mortality rates in these regions are significantly impacted by a lack of access to prevention, diagnosis, and treatment. The Trump administration’s freeze on foreign aid through the US Agency for International Development (USAID), followed by the agency’s shutdown, threatens decades of progress in TB efforts.

USAID, a leading donor providing about one-third of international TB funding, supports services through various partners. The abrupt cessation of support poses an existential challenge in high-burden TB countries, risking program shutdowns and leaving millions without essential TB services.

While it is unclear yet if the funding will eventually be restored, this disruption could reverse years of progress, increase mortality rates, and cause a resurgence of TB in vulnerable populations, severely affecting the overall TB treatment cascade.

TB is a challenging disease to diagnose, treat, and control. The dwindling resources and loss of public health capacity, coupled with existing limited access to care and difficulties maintaining both clinical and public health experts, exacerbate these challenges.

Currently, the only approved vaccine for TB is the century-old Bacillus Calmette-Guerin (BCG) vaccine, which is widely used despite its inconsistent effectiveness in adults.

The emergence of drug-resistant strains of Mycobacterium tuberculosis in geographically distinct communities remains an emerging concern. This is further compounded by a complex interplay of factors, including exposure to anti-TB drugs during treatment, person-to-person transmission, global travel, and inadequate TB care.

Anti-TB drugs, such as isoniazid, rifampin, pyrazinamide, and ethambutol, are essential for treating TB, but improper or incomplete use can lead to drug resistance.

These challenges are even more pronounced among Africa’s 268 million nomadic pastoralists. This is driven by a combination of individual behaviors, community beliefs, and systemic deficits, uniquely impacting nomadic communities and increasing their vulnerability to TB infection and spread.

Their mobility, driven by the need for water and pasture across different ecological zones, complicates TB control efforts. This mobility disrupts consistent treatment, delays diagnoses, and facilitates the spread of drug-resistant TB strains.

Additionally, cultural norms and preconceived ideas about TB lead many individuals to actively avoid TB diagnoses by refusing to seek treatment after exposure or when symptoms emerge.

The general treatment for TB requires at least six months of antibiotics, meaning that individuals must maintain access to health services for this entire period. With the everyday demands of life, this is a lot to ask of anyone. But, for those in nomadic communities, this long treatment period is nearly impossible to achieve because their migratory lifestyles often prevent them from receiving long-term care at a single healthcare facility.

The lack of healthcare-seeking behaviors among individuals can partly be attributed to social stigma associated with HIV/AIDS. TB is a common co-infection of HIV/AIDS, leading to the belief that someone infected with the bacteria causing TB must also be infected with this virus, extending existing stigma against HIV patients to those with TB.

Finally, at the healthcare system level, some of the most significant TB care challenges are prompt detection, consistent treatment, and case profiling.

The healthcare system must address these challenges to improve TB outcomes, particularly in nomadic communities where mobility and cultural factors complicate access to care. Ensuring timely diagnosis and maintaining consistent treatment are critical to controlling the spread of TB and preventing the development of drug-resistant strains.

Effective case profiling can help tailor interventions to the specific needs of different communities, ultimately improving health outcomes and reducing the burden of TB.

While it’s unclear yet if global TB funding will eventually be restored, this disruption could reverse years of progress, increase mortality rates, and cause a resurgence of TB in vulnerable populations across the world.

As the world steps up efforts to end the global epidemic on March 24, 2025, addressing these challenges is more crucial than ever.

Caroline Mullen, Pablo Troop, and Brenna Keam are Research Assistants in the Ignite Lab. Dr. Julius Odhiambo is an Assistant Professor of Public Health. Ignite Lab is a multidisciplinary research lab based at the William & Mary Global Research Institute and focuses on the effective, efficient, and equitable distribution of global health resources.

Tuberculosis remains the leading infectious cause of death in the world, responsible for 1.6 million deaths a year, and is an active and acute crisis in many countries. Credit: Athar Parvaiz/IPS

By Maria Beumont
NEW YORK, Oct 13 2023 (IPS)

At the end of September, two weeks after the United Nations held a High-Level Meeting on Tuberculosis (TB), a torrential storm dropped 6” of rain on New York City. The intensity of the storm recalled that of Hurricane Ida two years earlier, which—in the largest city in the United States—damaged more than 3% of buildings, killed 13 people, and left 380 families homeless.

As recently as the early 1990s, New York City was a hotspot for TB. Throughout the decade, the city spent more than a billion dollars to contain the disease, which had become entrenched in its more impoverished communities—including those without homes. TB has plagued the world for millennia, for as long as communities have been separated by wealth.

If rises in human displacement and hunger are tragic first order effects of climate change, TB is a giant, looming second order effect. Displacement and malnutrition are established risk factors for TB, and both are exacerbated by climate change

Today, it remains the leading infectious cause of death in the world, responsible for 1.6 million deaths a year, and is an active and acute crisis in many countries.

The low-resource settings where much of the world’s TB burden is concentrated are the same places set to bear most of the impact of climate change and whose health systems are ill-equipped to handle added burden.

In August, two typhoons slammed into the coast of Southern China, forcing the evacuation of almost one million people. At the same time, a surprise cyclone hit Southern Brazil, leaving 1,600 people without homes. And earlier this year, Cyclone Freddy hammered Mozambique and Malawi, forcing hundreds of thousands of people into temporary shelter. All four countries have a high burden of TB cases, according to the World Health Organization (WHO).

India, another high-burden TB country, has been hit hard this year by heat waves and drought. It is estimated that 17 million Indians will face climate-change induced hunger by 2030. Increases in climate-induced food insecurity will only add to the existing crisis; the UN estimates that 735 million people around the world faced food shortage in 2022.

If rises in human displacement and hunger are tragic first order effects of climate change, TB is a giant, looming second order effect. Displacement and malnutrition are established risk factors for TB, and both are exacerbated by climate change. Though such impacts are not directly tracked, we can assume that recent climate-enhanced superstorms, heat waves, and droughts amplified the TB burden in Brazil, China, India, Malawi, and Mozambique.

While climate change is a leading topic at major global forums around the world, including at the UN, the TB pandemic remains largely ignored. In 2018, TB appeared on the global radar when the UN held its first High-Level Meeting (HLM) on TB. National delegations agreed to four ambitious goals on providing treatment to people with TB, preventive treatment to people at risk, and drastically increasing the amount of funding devoted to tackling the disease and developing new tools for this effort.

The world was already behind in fulfilling these commitments when the COVID-19 pandemic hit, derailing TB funding and care. As COVID-19 raged, the limited funding and attention for TB had to be diverted to face the new threat. As a result, TB deaths increased for the first time in more than 20 years. Ultimately, not one of the primary commitments from the HLM were met.  As climate change intensifies along with the effects of displacement and malnutrition, it may lead to future TB outbreaks and further strain already fragile health systems.

Despite these setbacks, there have been notable achievements in TB research and care. A treatment for the highly drug-resistant forms of the disease was approved by the US FDA and other regulatory authorities, and was endorsed by the WHO. Additionally, the US Centers for Disease Control and Prevention issued guidance on a four-month treatment for drug-sensitive TB, reducing treatment duration for the first time in decades.

TB researchers remain optimistic. Changing the way we fight TB is achievable, and we have a strong research pipeline of promising new TB treatments, diagnostics, and vaccines. Breakthroughs are on the horizon—and they are sorely needed. The impact of safe, shorter, effective, and affordable tools to control TB is anticipated to be significant.

At the UN’s second High-Level Meeting on TB this past September, another batch of ambitious goals were adopted—including a six-fold increase in funding for services and research. During the COVID-19 pandemic, we all witnessed the results of focused efforts and appropriate funds. The same is true for TB: with adequate funding and resources, we can develop the next generation of tools to fight TB. Support from world leaders now is critical, as we can end one of humanity’s oldest diseases if we come together, while also mitigating the impact of one of the climate change crisis. This opportunity cannot be missed.

Excerpt:

The progress made in HIV prevention is nothing short of a global success story. It is time that TB caught up to HIV. Medicine is simply too advanced for us to tolerate how one disease can be beaten back yet another continues to flourish. Credit: Jeffrey Moyo/IPS.

By Violet Chihota
JOHANNESBURG, Jul 26 2023 (IPS)

Before COVID-19 came along, the two most lethal infectious diseases were HIV and tuberculosis (TB). Even though HIV still lingers, with 1.5 million people contracting the infection every year, epidemiologists point to the availability of many HIV prevention options as a primary reason for the decreasing caseload.

According to the World Health Organization (WHO), over the past two decades, new HIV infections decreased by 49%, HIV-related deaths decreased by 61% and an estimated 18.6 million lives were saved because of new treatments that minimise the infection and prevent its spread.

We have so many options for HIV prevention at our disposal, including the dapivirine vaginal ring, oral Pre-Exposure Prophylaxis (PrEP), harm reduction for people who use drugs, condoms for both men and women, voluntary medical male circumcision and the recently approved long-acting cabotegravir, with other options in development.

We have a suite of prevention tools because everyone is different, and people need to be able to choose their methods according to the way they live their lives. We observe a similar abundance of choice within family planning with oral pills, a variety of injectables, intra-uterine devices and condoms—we share this prevention method with HIV programs.

The urgency of the need is clear: an estimated 1.6 million people lost their lives to the disease in 2021, the second consecutive year the death toll went up after 14 years of progress. In Africa, an estimated 2.5 million people contracted the disease in 2021, one million of which were never diagnosed and treated

We do not have this many options for TB prevention, but the world needs to adapt to embrace choice if we are to meet the globally agreed-upon goal of reducing TB deaths by 90% by 2030—referred to as the “End TB targets.”

The urgency of the need is clear: an estimated 1.6 million people lost their lives to the disease in 2021, the second consecutive year the death toll went up after 14 years of progress. In Africa, an estimated 2.5 million people contracted the disease in 2021, one million of which were never diagnosed and treated.

Yet there are glimmers of good news. Despite the COVID-19 pandemic, estimates of TB incidence have slowly declined over the past few years in Angola, Ethiopia, Gabon, the Republic of Congo, Sierra Leone, South Africa, Tanzania and Zambia—all countries with high burdens of TB.

Of these countries, Zambia has also had success in finding and diagnosing an increasing number of these infections; the pandemic impacted the surveillance efforts of the other governments.

As for HIV, there is no effective vaccine to prevent TB in adults: the BCG vaccine only prevents severe TB in children. However, there are ways to prevent TB when someone is potentially exposed to an infected person. In the workplace or when a family member at home becomes sick, for example, prevention starts with masking, which was traditionally used in clinical care settings. The other ways work through prophylactic regimens. For TB, we initially only had isoniazid that could be taken for six, nine, 12 or 36 months depending on country guidelines, but now we have shorter regimens that allow for patient choice.

These options include regimens lasting one (1HP) and three months (3HP), with different combinations of the antibiotic drugs rifapentine and isoniazid, all with vitamin B6 supplements to help counter some of the side effects of treatment. There is also a three-month regimen of rifampicin and isoniazid (often given to children and adolescents) and a four-month regimen of rifampicin alone. Longer courses of isoniazid taken for 6–36 months also remain options, though most people are eligible to take a shorter rifapentine- or rifampicin-based regimen and should be given the choice to do so.

We need to do a better job of making sure that people at risk of TB have access to the full range of prevention options. A recent peer-reviewed study underlines this point, estimating that tracing the personal contacts of people diagnosed with TB and providing them with prevention treatment would save the lives of 700,000 children under the age of 15 and 150,000 adults by 2035.

Even the financial benefits of the prevention program, in terms of increased economic productivity, would outweigh the costs. Nobody questions the need to have options for HIV prevention or family planning, but questions arise when trying to roll out a one-month TB prevention regimen when there’s already a three-month regimen available. We need them all. We also need to collect more data to differentiate which prevention regimens are best for each patient type to ensure success.

The WHO guidelines for preventive TB treatment create the possibility of choice among TB preventive treatments by not ranking the regimens by preference or effectiveness. But health care facilities and outreach programs need to embrace that range of options and make sure that a choice exists in practice. Supply chains may limit choice initially, but if there is no demand for more options from providers, there is no impetus to expand the supply chains.

The progress made in HIV prevention is nothing short of a global success story. It took a combination of scientific ingenuity and innovation, combined with an intensive dedication of resources that made a range of preventive options available around the world.

It is time that TB caught up to HIV. Medicine is simply too advanced for us to tolerate how one disease can be beaten back yet another continues to flourish.

Violet Chihota is an Adjunct Associate Professor and Chief Specialist Scientist at the Aurum Institute. She has been a researcher in global health for over 10 years, designing and managing the conduct of clinical research studies in South Africa, Zimbabwe, Botswana, Cameroon, Georgia, India and Malaysia.

A doctor talks to a TB survivor at a clinic in Manilla, Philippines. Credit: Getty Images for TB Alliance

By Ed Holt
BRATISLAVA, May 2 2023 (IPS)

While there is no established causal relationship between climate change and tuberculosis (TB), studies have begun to highlight the potential impact its effects could have on the spread of the disease.

Undernutrition, HIV/AIDS, overcrowding, poverty, and diabetes have all been identified as TB risk factors that are worsened by climate change. Worryingly, many countries with high burdens of TB, including, for instance, drought-hit Ethiopia, Indonesia, Kenya, and Peru, have suffered from the kind of extreme weather associated with a heating planet.

But despite vying with COVID-19 for the grim distinction of the world’s deadliest infectious disease, claiming 1.6 million lives in 2021, TB is not often talked about in connection with climate change, with the link often overlooked by policymakers.

TB experts say this must change as the climate crisis accelerates.

“The effects of climate change, such as its impact on migration, for instance, are getting attention. What we want to see is for that attention to also get drawn to its effects on TB,” Maria Beumont, Chief Medical Officer at TB Alliance, a global nonprofit organisation developing TB drugs, told IPS.

In recent years, disease experts and climatologists have sounded increasingly dire warnings about the potential impact of the climate crisis on the spread of lethal diseases.

The latest report from the Intergovernmental Panel on Climate Change (IPCC) warned of the health impacts of global heating, including an increase in the incidence of infectious diseases. Meanwhile, other research has shown how changes in climate have aggravated the risks of hundreds of infectious diseases worldwide.

But much of the discussion around that has focused on how higher temperatures and increased incidence of flooding and drought could drive more vector, food and water-borne diseases with diseases.

What has often been overlooked in these conversations, say Beumont and others, is how the effects of the climate crisis could worsen what is de facto a global TB pandemic.

Part of this is because of the nature of those effects in relation to TB.

“The potential impact of climate change [on TB] is more indirect than with some other infectious diseases,” Dr Mohammed Yassin, Senior Disease Advisor, TB, at the Global Fund to Fight AIDS, Tuberculosis and Malaria, told IPS.

TB experts point to how more frequent and more devastating natural disasters linked to climate change, or simply places on the planet becoming too hot to be habitable, are leading to mass displacement, which can create ideal conditions for TB to spread.

“Mass displacement can lead to overcrowding and poor living conditions of those displaced. If some of those people already have symptoms of TB, there is a higher chance of it spreading. There would also be people living under stress, and facing malnutrition, which are factors adding to the potential for TB to spread,” said Yassin.

Displacement also raises issues with access to healthcare for the displaced, which can negatively affect the management of treatment for those with TB because patients need to take treatment daily. Interruption of treatment can leave them infectious for longer and at risk of developing drug-resistant TB, which in turn is much more difficult and expensive to treat.

But displacement would also impact the treatment of those with other conditions, such as HIV and AIDS and diabetes, which weaken immune systems and leave people more susceptible to TB.

Meanwhile, displaced people are likely to find themselves living in crowded areas where, in the absence of adequate screening and diagnostic procedures, TB could spread.

But displacement is far from the only problem. Both extreme droughts and flooding can impact food security, devastating crops and killing livestock and leading to malnutrition and undernutrition—known risk factors for TB.

The impact of extreme weather on health, particularly TB, is already being seen in some parts of the world.

Somalia is in the grip of severe drought following five consecutive failed rainy seasons—something which the UN has said has not been seen for four decades—with five million people facing acute food shortages and nearly two million children at risk of malnutrition, according to the UN.

TB is a major cause of death in Somalia, and late last year, with TB services largely non-existent in settlements for displaced persons, the Global Fund committed USD 1.9 million for food support for thousands of TB patients and outreach activities in settlements. Officials at the time emphasised the importance of such action to help reach the most vulnerable and stop TB from spreading.

Meanwhile, the devastating floods in Pakistan last year, which affected an estimated 33 million people, not only brought an immediate threat of diseases such as malaria and dengue but interrupted vital vaccination programmes, including TB.

“The impact of flooding on TB is usually seen sometime later, but it, of course, has an immediate impact in disrupting treatment which can lead to problems such as drug-resistant TB,” said Yassin.

TB experts are calling for governments and leaders within the TB community itself to begin paying more attention to the issue and start thinking about current TB programs and where changes need to be made to deal with these potential impacts.

Some groups, like TB Alliance, are looking to mitigate some of these impacts through treatment developments. The group recently developed a new TB treatment regimen, BPaL, with a much shorter treatment length and fewer of the sometimes very toxic side effects of previous regimens.

An oral-only regimen involving only a few pills a day, it has been widely praised by patients and experts for the relative ease with which it can be taken, notably in Ukraine, where it has recently been rolled out programmatically and used among the many millions displaced there because of the Russian invasion.

“What we are focusing on is trying to find solutions to make treatment safer and shorter, which would overcome some of the negative effects of climate change related to TB, for instance, displacement, as there would be less chance of treatment interruption with shorter treatment,” said Beumont.

A doctor studies x-rays of a TB survivor at a clinic in Kyiv, Ukraine. Credit: Getty Images for TB Alliance

Yassin said that investment in health systems, especially in low-income countries which have some of the world’s highest TB burdens and where healthcare is already under-resourced, is also crucial.

“We learnt from Covid that health systems can’t cope with a pandemic, and TB is actually a pandemic. It is very important for countries to think about strengthening their health systems and making them more resilient. There needs to be investment now to prepare the systems for a pandemic, including climate change-driven TB,” said Yassin.

“There was a collapse of some healthcare systems during Covid, and because of that, all resources in some countries went to dealing with that, and TB was forgotten, and the TB burden of those countries rose. We need to invest now, not wait for another pandemic. We need more resources,” he added.

Meanwhile, others say that alongside these measures, individual, non-climate-specific interventions could help.

Dr Krishnan Rajendran of the ICMR-National Institute for Research in Tuberculosis (NIRT) in India, which has the highest burden of TB in the world according to the World Health Organisation, told IPS that lessons learnt from the Covid pandemic could be used to reduce TB spread.

“National and local authorities could take preventive measures, such as at least encouraging people to wear masks in seasons where TB incidence is high,” he said.

Whatever efforts are made to deal with the impact of climate change on the disease, they need to be made soon, said Yassin.

“We shouldn’t wait for climate change impacts [to fuel the spread of TB] before we act—we should do something now and deal with TB to prevent more deaths and disabilities,” he said.

IPS UN Bureau Report

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