Global TB Report 2024

The Global Tuberculosis Report 2024 by the World Health Organization (WHO) provides an in-depth analysis of the global burden, progress, and challenges in tackling tuberculosis (TB) across nations. The report highlights significant milestones achieved in the past year while underscoring persistent obstacles, especially in countries with high TB burdens, such as India. India’s commitment to eliminating TB by 2025, five years ahead of the global deadline, has spurred considerable advancements in diagnosis and treatment. However, the report also emphasizes that many countries, including India, face substantial hurdles in meeting these ambitious goals.

Key Findings of the Global Tuberculosis Report 2024

The report outlines several critical data points that illustrate the global TB situation:

• Global TB Incidence Trends: In 2023, approximately 8.2 million new TB cases were recorded globally, which marked an increase from 7.5 million cases in 2022. This figure is the highest reported by WHO since 1995. The global surge in TB cases reflects challenges in controlling the disease in many regions, particularly in low- and middle-income countries (LMICs).
• TB Mortality: An estimated 1.25 million TB-related deaths occurred worldwide in 2023, a slight decrease from 1.32 million deaths in 2022. Although the reduction in deaths is promising, the mortality rate remains concerning, especially in vulnerable populations with limited access to healthcare.
• Demographics of TB Cases: A significant portion of the global TB burden is concentrated in just 30 low- and middle-income countries. Five countries—India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), and Pakistan (6.3%)—contribute to 56% of the total global TB cases. This skewed distribution highlights the need for focused efforts in these regions to combat the disease effectively.
• Gender and Age Distribution: 55% of global TB cases were found in men, while 33% occurred in women, and 12% affected children and young adolescents. These statistics demonstrate the need for gender-sensitive and age-specific interventions to target different segments of the population.

India’s Progress in TB Elimination

India, as the country with the largest share of the global TB burden, has shown notable progress in recent years. The National Tuberculosis Elimination Programme (NTEP) has played a key role in reducing TB incidence and expanding treatment coverage.

• TB Incidence Decline: From 2015 to 2023, India achieved a 17.7% decline in TB incidence, dropping from 237 cases per lakh in 2015 to 195 cases per lakh in 2023. This reduction, which exceeds the global average of 8.3%, reflects the impact of India’s concerted efforts through various national initiatives.
• Treatment Coverage: In 2023, India’s treatment coverage rose to 89%, compared to 72% in 2015. This improvement signifies progress in closing the gap between diagnosed cases and those receiving timely treatment, thereby preventing further transmission of the disease.
• TB Mortality Reduction: The country’s mortality rate from TB declined from 28 per lakh population in 2015 to 23 per lakh in 2022, showing significant progress in reducing deaths due to TB. However, much more work remains to be done to meet the ambitious End TB Strategy goals set by the WHO.

Challenges in Achieving End TB Targets

Despite progress, India faces several critical challenges that could hinder its ability to meet the goal of eliminating TB by 2025.

• Missed End TB Strategy Milestones: The WHO’s End TB Strategy requires countries to reduce TB deaths by 75% and TB incidence by 50% from 2015 levels. As of 2024, India is falling short of these targets, making it unlikely that the country will achieve the reduction in TB deaths to 7 per 1,00,000 or lower the incidence to 118.5 per 1,00,000 by 2025.
• Insufficient Global and Domestic Funding: Global funding for TB control remains critically underfunded. In 2023, available funds in LMICs were only USD 5.7 billion, far short of the USD 22 billion target set for 2027. This funding gap has limited progress, particularly in research and development (R&D) for new TB diagnostics, drugs, and vaccines.
• Catastrophic Health Costs: Approximately 20% of Indian households with TB face catastrophic health expenses. This financial burden is a major barrier to effective TB control, particularly in rural and underserved regions where poverty rates are higher.
• Multidrug-Resistant TB (MDR-TB): India bears 27% of the global burden of MDR-TB, a severe form of TB caused by strains of Mycobacterium tuberculosis that are resistant to the most potent first-line drugs—isoniazid and rifampicin. MDR-TB poses a major challenge to the country’s TB elimination efforts, as treatment is more complex, costly, and requires prolonged use of second-line drugs.

Major Risk Factors Driving the TB Epidemic

Several risk factors significantly influence the spread and treatment outcomes of TB. These include undernutrition, HIV infection, diabetes, alcohol consumption, and tobacco use.

• Undernutrition: In 2022, nearly 7.44 lakh TB patients in India were reported to be undernourished. Addressing malnutrition is crucial, as it increases susceptibility to infection and worsens treatment outcomes. The Nikshay Poshan Yojana, which provides Rs 500 per month to TB patients for nutritional support, is one of India’s key interventions to tackle this issue.
• HIV Co-infection: People living with HIV have a 20-times higher risk of developing active TB. In 2022, 94,000 TB patients in India were co-infected with HIV, necessitating integrated care and treatment services to address both conditions simultaneously.
• Diabetes: Diabetes increases the likelihood of contracting TB by two to three times. Of the 3.70 lakh TB patients with diabetes globally in 2022, 1.02 lakh were in India. Managing co-existing diabetes and TB remains a significant challenge, as it is associated with higher risks of MDR-TB and poorer treatment outcomes.
• Alcohol and Tobacco Use: Excessive alcohol consumption and tobacco use also exacerbate the TB epidemic. In 2023, 7.1% of TB patients in India were identified as alcohol users, while 11% were identified as tobacco users. Encouragingly, 32% of tobacco users were linked to cessation services, but more needs to be done to reduce these lifestyle risk factors.

India’s Commitment and Initiatives to Combat TB

India has launched several high-level initiatives aimed at accelerating TB elimination by 2025.

• National Tuberculosis Elimination Programme (NTEP): This program is the cornerstone of India’s TB control efforts, with a focus on providing universal access to TB care, improving early diagnosis, and expanding treatment coverage.
• Pradhan Mantri TB Mukt Bharat Abhiyan: Launched to strengthen community-based support systems, this initiative encourages community participation in patient care and aims to reduce the stigma associated with TB.
• National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025): The NSP outlines the strategic roadmap to eliminate TB in India by improving diagnosis, treatment, and preventive measures.
• Nikshay Poshan Yojana: Aimed at reducing malnutrition among TB patients, this scheme provides nutritional support to those undergoing treatment, helping to mitigate one of the key risk factors for TB.
• TB Harega Desh Jeetega Campaign: This awareness campaign focuses on mobilizing the public, especially in rural areas, to participate in TB detection, prevention, and treatment efforts.

Way Forward

Despite the numerous challenges, there are several strategies that India and the global community can adopt to enhance TB control efforts:

• Expanded Tuberculosis Preventive Therapy (TPT): Scaling up TPT with shorter drug regimens is essential to improving the prevention of latent TB infections and reducing transmission rates.
• Innovative Diagnostics: The use of molecular diagnostic tests for early detection of TB should be expanded, especially in rural and underserved areas. Faster and more accurate diagnostics will improve treatment outcomes and reduce transmission.
• Decentralized TB Services: Decentralizing TB care through Ayushman Arogya Mandirs will increase accessibility to treatment, especially in remote regions. Community-based healthcare delivery systems are critical to addressing the unique needs of different populations.
• Community-Based Patient Support: Programs like the Pradhan Mantri TB Mukt Bharat Abhiyan should be scaled up to increase community involvement and support systems, improving patient care and helping to eliminate the stigma surrounding TB.
• Research on Adult BCG Vaccination: Conducting comprehensive studies on the efficacy of BCG vaccination in adults could provide new insights into preventing TB and further reduce the burden of the disease.

In conclusion, while the Global Tuberculosis Report 2024 highlights significant progress in the fight against TB, it also underscores the need for sustained efforts, both globally and within India.