Tuberculosis (TB) is an airborne illness that many deem to be a relic of the past. Yet, after years of decline in high-income nations like the UK and US, TB diagnoses are on the rise.

According to the UK Health and Safety Executive, tuberculosis cases in the UK are projected to increase by 13% in 2024, reaching a total of 5,480 diagnoses.

Although this number is relatively modest compared to other high-burden nations, England remains just below the World Health Organization (WHO) threshold for “low incidence” status, which is defined as 10 cases per 100,000 people.

These statistics, along with similar trends in the US, indicate that our progress has plateaued, hindering our path to TB eradication.

A Wake-Up Call

So, is tuberculosis making a resurgence? In short, it never fully disappeared.

Tuberculosis remains the deadliest infectious disease globally, claiming approximately 1.23 million lives in 2024 alone—more than HIV and malaria combined—and ranks among the top 10 causes of death worldwide.

According to WHO, over 10 million individuals contract tuberculosis each year, with a shocking quarter of these going undiagnosed and untreated. The COVID-19 pandemic has further hampered years of progress in TB control, but it’s only part of the picture.

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, spreading through the air when an infectious person coughs, sneezes, sings, or speaks.

Common symptoms include a persistent cough lasting three weeks or more, fever, night sweats, weight loss, and fatigue. While TB commonly affects the lungs, it can impact any organ in the body.

Despite the availability of effective treatments for decades, they remain imperfect. A cure requires months of antibiotics, which can be difficult to access in certain regions. The Bacillus Calmette-Guérin (BCG) vaccine offers some protection to young children against severe forms of TB, but it does not reliably prevent the contagious lung disease prevalent in adults.

It’s crucial to note that most individuals who inhale the bacteria do not fall ill. An estimated a quarter of the global population is infected with tuberculosis, with their immune systems keeping it dormant. Latent tuberculosis can be detected through skin and blood tests, and preventive antibiotics are often prescribed to avert progression.

Individuals with weakened immune systems, including those with HIV or diabetes, those undergoing cancer treatments, and those on specific medications for conditions like rheumatoid arthritis, are at heightened risk of developing TB.

An Unbalanced Burden

Tuberculosis is closely linked to poverty and the living and working conditions of individuals. Factors like overcrowded or poorly ventilated housing, homelessness, low income, malnutrition, smoking, and alcohol dependence can elevate vulnerability to TB.

People in disadvantaged communities tend to be more frequently infected and less often diagnosed early, resulting in generally poorer health outcomes. Social stigma, healthcare system gaps, and misinterpretation of symptoms can also delay treatment.

Consequently, a human-centered model that merges medical care with psychotherapy and financial and social support is increasingly recognized as vital for effectively combating tuberculosis.

While TB impacts individuals of all genders, WHO data indicates that men aged 15 and older carry a disproportionately heavy burden, with an estimated 54% of TB cases in 2024 occurring in men, compared to 35% in women and 11% in children and adolescents.

Men also encounter greater barriers to diagnosis and treatment, with a 45% higher mortality rate after initiating treatment compared to women.

These disparities stem from various factors, including elevated rates of smoking and alcohol consumption among men, as well as occupational hazards and gender norms that deter them from seeking care.

Women and individuals of diverse sexual orientations and gender identities face their own distinct challenges. A gender-sensitive and human-centered approach is crucial for achieving the goal of tuberculosis elimination for everyone.

A Turning Point

The good news is that scientific advancements are leading the fight against tuberculosis to new heights, with quicker diagnoses, shorter treatments, and promising vaccines.

Rapid molecular tests like Xpert MTB/RIF and Truenat can identify tuberculosis and drug resistance within hours instead of weeks. AI-assisted chest X-rays are also enhancing early detection in areas lacking radiologists.

Treatment regimens have become both shorter and safer. Current TB treatments may only take one month, while some drug-sensitive cases require four months, and drug-resistant cases can be treated in six months.

Vaccine research is progressing as well, with candidates like M72/AS01E entering late-stage clinical trials. Although these advancements signify considerable progress, ensuring equitable access for all, especially in low-resource settings, remains a significant challenge.

Research from Liverpool’s Tuberculosis Research Center highlights that stigma, discrimination, poverty, and structural barriers significantly affect the experiences of those living with TB.

Understanding the lived experiences of TB patients, as well as the obstacles and enablers in their treatment trajectories, is essential to ensure that no one is left behind.

For effective human-centered TB care, collaborations between governments, researchers, and affected communities are underway, integrating clinical care with education, mental health support, and financial assistance. Yet, there’s still much more to achieve.

The UK’s recent pledge of £850 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria from 2027 to 2029 reaffirms this commitment, contributing to efforts that have reportedly saved 70 million lives since 2002.

However, it is important to note that this pledge reflects a 15% decrease from the previous financial cycle, which adds to the sobering reality of diminishing development funding impacting progress in the fight against tuberculosis.

Reductions in international aid have weakened tuberculosis programs in heavily burdened nations, with repercussions likely to extend beyond borders. Persistent political will and investment in locally relevant, people-centered strategies are crucial to achieving the goal of TB elimination for all.

So, should you be concerned about contracting tuberculosis? If you reside in the UK, generally the answer is no. TB remains rare, and infection risk for most individuals is minimal unless they have had extended, close contact with someone infected.

If your cough persists for over three weeks, particularly when accompanied by symptoms such as fever, weight loss, or night sweats, consult your physician.

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