World TB Day: A Call to End TB

World Tuberculosis Day, observed on 24 March each year, is designed to raise public awareness about the devastating health, social, and economic consequences of tuberculosis (TB) and to step up efforts to end the global TB epidemic. This year’s theme, “Yes! We Can End TB: Commit, Invest, Deliver,” is a bold call for hope, urgency, and accountability.

Tuberculosis, caused by the bacterium Mycobacterium tuberculosis (discovered by Robert Koch on March 24^th, 1882), is a highly contagious airborne disease that primarily affects the lungs and causes pulmonary tuberculosis but also affects other parts of the body such as the pleura, lymph nodes, abdomen, genitourinary tract, skin, joints, and bones, which causes extrapulmonary tuberculosis. Despite being preventable and treatable, TB remains a leading cause of death worldwide from a single infectious agent, following three years in which it was replaced by coronavirus disease (COVID-19). It disproportionately impacts adults in their most productive years but endangers people of all ages, particularly in low- and middle-income countries, where over 95% of cases occur.

The Global TB Burden

Globally, the incidence of TB continued to increase in 2023, with an estimated 10.8 million cases, an increment from 10.7 million in 2022. Regionally, TB incidence rises in the Americas and Western Pacific, while negligible descent was noticed in the Eastern Mediterranean and South-East Asia. The African region has observed a steady decline since 2010. Geographically, 87% of TB cases happened in 30 high-burden countries, with India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), Pakistan (6.3%), Nigeria (4.6%), Bangladesh (3.5%), and the Democratic Republic of the Congo (3.1%) accounting for over two-thirds of global cases. Males (55%) had the highest TB burden, followed by females (33%) and children (12%). In 2023, TB caused an estimated 1.25 million deaths, including 1.09 million among HIV-negative individuals and 161,000 among people with HIV.

In 2023, the Global TB Report stated that Nepal has an estimated 70,000 TB cases and 18,000 TB-associated deaths in 2022. In the 2079/80 fiscal year, the country reported 37,447 national TB notifications, with 8.0% of these cases manifesting in children under 15 years of age.

Transmission and Clinical Manifestations

TB spreads predominantly through aerosolized droplet nuclei (1-5 μm) released when transmissible individuals cough, sneeze, sing, or talk. Causes like cough strength, lung cavities, sputum viscosity, and ventilation influence transmission. If remain unaddressed, smear-positive patients can infect 10-15 people yearly. In most cases, pulmonary tuberculosis emerges slowly without a clear onset of signs and symptoms. And diseased patients have symptoms like loss of appetite, weight loss, fever, night sweats, chills, weakness, cough, chest pain, and coughing up blood. However, development can be so subtle that symptoms may go unnoticed, making early detection challenging.

The Socio-Economic Burden of Tuberculosis

TB just cannot be considered solely as a health issue; it is also a significant socio-economic problem. It disparately affects vulnerable populations living in poverty, facing marginalization, or suffering from malnutrition. Rapid urbanization along with population growth has accelerated TB risk by creating conditions such as overcrowded living spaces, inadequate housing, and poor ventilation. Additionally, other well-documented risk factors, including HIV infection, diabetes, smoking, close contact with TB patients, alcohol consumption, and malnutrition, further increase susceptibility. Cultural, economic, and geographical barriers complicate disease management, leading to poorer outcomes and creating a vicious cycle of ill health and financial distress. Today, TB is the culprit for the highest number of disability-adjusted life-years lost among infectious diseases, exceeded only by malaria and HIV.

Challenges in the Fight against TB

The fight against TB faces countless, composite, and interrelated challenges. The foremost pressing concern is drug-resistant tuberculosis (DR-TB), a powerful factor of antimicrobial resistance (AMR). Alarmingly, TB is reemerging as DR-TB, even in countries with previously zero or minimal drug sensitive TB cases. This swing highlights the extensive nature of TB transmission and the urgent need to gear up against the growing crisis of antimicrobial resistance. The principal warning signal is resistance to rifampicin, the most potent first-line TB drug, as it severely limits treatment options and complicates efforts to control the disease. DR-TB arises from inadequate or incomplete treatment, making infections more difficult to treat and accelerating the risk of transmission. If we look more deeply, other major hindrances are chronic funding gaps, restricting access to essential diagnostic tools and treatments. In low and middle income countries, TB affected families experience catastrophic financial burdens, financial setbacks, and chronic illness, driving families further into poverty. Rising global crises, such as climate change, conflicts, migration, displacement, and the risk of pandemics, further increase the burden on healthcare systems, the reallocation of resources, and rattle TB diagnosis and treatment facilities. Without urgent action to develop new treatment regimens and strengthen healthcare delivery, drug-resistant TB threatens to hinder decades of progress in global health.

Prevention and Control

Preventing TB transmission a multi-faceted approach is essential. The bacillus Calmette–Guérin (BCG) vaccine is highly efficient in safeguarding children from severe forms of TB, such as miliary TB and TB meningitis, and is also included in most countries’ routine immunization schedules. A crucial point to reduce the spread of the disease is early identification and prompt treatment of notified cases. Drug-sensitive tuberculosis is treated initially with 2 months of Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), and Ethambutol (E), followed by 4 months of Isoniazid and Rifampicin (4HR). Shorter regimens like BPaLM (Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin) are strongly suggested for treatment of drug-resistant TB. Active TB diagnosed individuals should avoid close contact to reduce transmission. In addition, wearing a mask, covering the mouth when coughing or sneezing, and ensuring proper ventilation in living spaces can substantially decrease the risk of transmission. Together, these steps play a vital role in controlling and preventing the spread of TB.

Global Commitments and Path Forward

In 2014 and 2015, WHO and UN Member States made a global commitment to end the tuberculosis epidemic by adopting the WHO End TB Strategy, anticipating a world free of TB, with zero mortality, disease, and suffering caused by the illness. The United Nations Sustainable Development Goals (SDGs) strategy also lines up with the targets and guidelines to eliminate the global TB epidemic.

However, commitments alone are inadequate to end TB. We need real action: rapid implementation of WHO guidelines, powerful national strategies, and total financing. TB cannot be conquered without proper financing. A bold, distinctive viewpoint is essential to fund innovation, close gaps in access to prevention and care, and breakthrough research. Turning responsibility into action means scaling up proven interventions: early detection, diagnosis, preventive treatment, and quality care, especially for drug-resistant TB. Success rests on community initiatives, citizen engagement, and inter-sectorial cooperation.

A Call to Action

To combat TB demands fearless, diversified approaches and steady commitment. International leaders and policymakers must convert pledges into action by scaling up efforts, investing in innovation, and managing poverty related factors that fuel the epidemic.

Together, we can end TB-but only if we act now!

                                                                     Dr. Khadka is currently working as Assistant Professor at Chitwan Medical College, Nepal