India also has the highest number of multi-drug-resistant TB (MDR-TB) cases worldwide. Approximately 27 percent of global MDR/RR-TB cases in 2023 were in India.
Published Oct 30, 2024 | 12:46 PM ⚊ Updated Oct 30, 2024 | 1:16 PM
1 in 4 TB cases globally comes from India. (Supplied)
India accounts for one in four cases of tuberculosis (TB) globally, according to a new report by the World Health Organization (WHO).
The WHO report noted that five countries contributed to 56 perent of the worldwide TB cases—India (26 percent), Indonesia (10 percent), China (6.8 percent), the Philippines (6.8 percent), and Pakistan (6.3 percent).
Apart from contributing the highest number of cases, India also has the highest number of multi-drug-resistant TB (MDR-TB) cases worldwide.
“Approximately 27 percent of global MDR/RR-TB cases in 2023 were in India, followed by the Russian Federation (7.4 percent), Indonesia (7.4 percent), China (7.3 percent), and the Philippines (7.2 percent),” stated the report.
The WHO further revealed that around 8.2 million people were newly diagnosed with TB in 2023—the highest recorded figure since WHO began global TB monitoring in 1995. According to the report, 55 percent of those who developed TB were men, 33 percent were women, and 12 percent were children and young adolescents.
This marks a significant increase from the 7.5 million cases reported in 2022, positioning TB once again as the leading infectious disease killer in 2023, overtaking COVID-19.
The WHO’s Global Tuberculosis Report 2024 highlights mixed progress in the global fight against TB, with continued challenges such as critical funding gaps. Although TB-related deaths decreased from 1.32 million in 2022 to 1.25 million in 2023, the total number of people falling ill with TB rose slightly to an estimated 10.8 million.
“The fact that TB still kills and sickens so many people is an outrage, especially when we have the tools to prevent, detect, and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General in a statement.
In 2023, 80 percent of global deaths caused by tuberculosis (TB) among HIV-negative individuals occurred in the WHO African and South-East Asia regions, with India alone accounting for 29 percent of these deaths. Combined, these regions represented 81 percent of total TB-related deaths among people with and without HIV, with India contributing 26 percent of the global total.
India and Indonesia were the two largest contributors to the global rise in newly diagnosed TB cases in 2022 and 2023, together making up 45 percent of the increase between 2021 and 2023.
Acknowledging progress in India, the WHO noted that only three countries have conducted a national TB prevalence survey since 2019: Cambodia, India, and Timor-Leste. “The survey in India, completed in 2021, was a key input in estimating incidence rates in this report,” the WHO report stated.
Among the 30 countries with a high TB burden, most showed progress in TB service coverage from 2000 to 2019, with China, India, Myanmar, Thailand, and Vietnam experiencing the largest gains (+30 index points or more).
However, progress stalled or even reversed in many countries between 2019 and 2021 due to the COVID-19 pandemic. In 2021, Brazil, China, and Thailand had the highest Service Coverage Index (SCI) values (around 80), while most other high-burden countries had SCI values between 40 and 60. The Service Coverage Index (SCI) is a unitless index that measures health service coverage on a scale of 0 to 100
In 2023, a substantial gap remained between estimated TB incidence and the reported number of newly diagnosed TB cases worldwide, with 10 countries accounting for most of this discrepancy. India, Indonesia, Pakistan, China, and Myanmar were the top five contributors, collectively making up about 50 percent of the global gap, with India alone accounting for 16 percent.
In 2023, the gap between the estimated number of new tuberculosis (TB) cases and those reported narrowed to about 2.7 million, down from pandemic levels of around 4 million in 2020 and 2021. This indicates that more cases are being reported now, which is a positive sign in the fight against TB.
This improvement reflects extensive national and global efforts to recover from COVID-19 disruptions in TB services. Coverage of TB preventive treatment has been sustained for people living with HIV and continues to improve for household contacts of people diagnosed with TB.
However, multidrug-resistant TB (MDR-TB) remains a critical public health crisis. Treatment success rates for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) have now reached 68 perent. Yet, of the estimated 400,000 people who developed MDR/RR-TB, only 44 percent were diagnosed and treated in 2023.
Global funding for TB prevention and care decreased further in 2023, falling significantly short of the required target. Low- and middle-income countries (LMICs), which bear 98 percent of the TB burden, continue to face severe funding shortages. Only $5.7 billion of the $22 billion annual funding target was available in 2023—just 26 percent of the global target.
International donor funding for TB in LMICs has stagnated at approximately $1.1–1.2 billion annually for several years. The United States remains the largest bilateral donor for TB.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria remains a crucial source of international funding for TB efforts in LMICs, though it is insufficient to cover essential service needs.
The report emphasizes that sustained financial investment is essential for effective TB prevention, diagnosis, and treatment efforts.
Global TB research also remains critically underfunded, with only one-fifth of the $5 billion annual target met in 2022. This funding shortfall hampers the development of new TB diagnostics, drugs, and vaccines. WHO is leading efforts to accelerate TB vaccine development, including through the newly launched TB Vaccine Accelerator Council.
For the first time, the report estimates that in all LMICs, half of TB-affected households face catastrophic costs—exceeding 20 percent of annual household income—to access TB diagnosis and treatment.
A substantial number of new TB cases are driven by five major risk factors: undernutrition, HIV infection, alcohol use disorders, smoking (particularly among men), and diabetes. Addressing these factors, alongside broader determinants such as poverty and economic status, requires coordinated multisectoral action.
“We are confronted with numerous formidable challenges: funding shortfalls, the catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics, and drug-resistant TB, which significantly contributes to antimicrobial resistance,” said Dr Tereza Kasaeva, Director of WHO’s Global Tuberculosis Programme. “It is imperative that all sectors and stakeholders unite to tackle these pressing issues and increase our efforts.”
Global milestones and targets for reducing the TB disease burden remain off-track, and substantial progress is needed to achieve other targets set for 2027 ahead of the next UN High-Level Meeting.
WHO further urged governments, global partners, and donors to act on commitments made at the 2023 UN High-Level Meeting on TB, emphasizing that increased funding for research, especially for new TB vaccines, is vital to accelerate progress and meet the 2027 global targets.
(Edited by Sumavarsha Kandula)
