Across the world, various actors commemorated World Tuberculosis Day this year on the backdrop of the recent publishing of the Global TB Report 2024 by the World Health Organization. The report highlighted progress and deep-seated challenges in the fight against one of the most devastating health challenges facing humanity. Despite medical advances in the field, the report—based on data from national ministries of health of at least 193 countries— confronts us with a sobering reality: TB remains the world’s deadliest infectious disease. In 2023 alone, it claimed 1.25 million lives and has returned to be the world’s leading infectious killer disease, following three years in which it had been replaced by the coronavirus disease (COVID-19).
In the same period, TB was also the leading killer of people living with HIV and a major cause of deaths related to antimicrobial resistance. It is disheartening to hear experts note that “TB is returning to take up its position as the most fatal infectious disease,”, a statement that reflects the continuous mortality and gap in efforts towards its eradication. However, political commitment to ending the TB epidemic has increased recently.
Since 1997, WHO has published a global TB report every year with the goal of providing a comprehensive, up-to-date assessment of the TB epidemic and progress in response efforts at global, regional, and national levels. Encouragingly, the TB incidence rate in the WHO African Region has declined yearly since 2010. This is recorded as a win for the continent and a stark contrast to other regions like the Americas and the Western Pacific, where cases are rising.
Despite the state of our healthcare systems, which often suffer from underfunding and neglect, countries such as Kenya, Tanzania, Zambia, and South Africa have made notable progress, with TB incidence reductions of over 20% since 2015. These numbers make us optimistic for the future ahead. Often, we question whether we are doing enough to fight TB, and while responses may vary, statistics like this help put things into perspective.
This progress in addressing TB incidents should certainly be applauded. However, we still have a long way to go. The global TB report indicates that Africa still bears 24% of the global TB burden, second only to South-East Asia. Although current research has provided valuable insight into TB transmission, diagnosis, and treatment, much remains to be discovered to decrease the incidence of and eventually eradicate TB effectively. In Africa, for example, one of the key challenges hindering TB’s diagnosis and cure is the late detection and treatment of cases, which allows the disease to spread unchecked in communities. To tackle these challenges, diagnostic technologies have become more widely available; however, many African countries still struggle with shortages of testing kits, laboratory infrastructure, and trained personnel—resulting in millions going undiagnosed and untreated, perpetuating the cycle of infection. Another factor that exacerbates the burden of TB is the high co-infection rate of TB and HIV. People living with HIV are significantly more vulnerable to TB due to weakened immune systems, and Africa accounts for nearly 85% of global TB/HIV co-infections. Without integrating TB and HIV services at primary healthcare facilities level, progress in tackling both epidemics will remain slow.
The Funding Shortfall
The financial reality of Africa’s TB response is not good and the region continues to grapple with financing gaps. Unfortunately, most of the funding available in the continent comes from international donors rather than domestic sources, leaving the region vulnerable to external funding cuts. The heavy reliance on external donors poses significant risks, particularly in times of global economic downturn or shifting priorities of funding agencies. Recent reductions in global health funding have put additional strain on TB programs, making it even more challenging to sustain vital interventions. Even more concerning is that many African governments allocate only a tiny fraction of their national health budgets to TB programs, even though TB is a major cause of mortality and economic burden on families. This lack of sustainable financing weakens TB control efforts, limiting access to diagnostics, treatment, and patient support services.
The funding shortfall extends to research and development for TB vaccines. As a continent, we lack the necessary investment to ensure local production and equitable distribution once a viable vaccine becomes available. Without adequate funding, the continent risks being last in line for access to potentially life-saving innovations. As such, increased funding for local TB research institutions and public-private partnerships in drug development will help African countries stay ahead in the fight against TB.
Locally-led Solutions
With this in mind, it is becoming increasingly clear that Africa needs to look within itself to tackle the TB crisis. Experts have long emphasized the need for homegrown solutions in Africa—ones that prioritize stronger health systems, increased domestic financing, and cross-sector collaboration. With the recent aid cuts, this need is now more urgent than ever. In real time, we are witnessing the consequences of failing to invest in local solutions, threatening to erase decades of progress. More than ever, we must follow through on the commitments we have set both globally and locally. While global strategies (including the WHO) provide a framework for action, TB programs must go beyond medical treatment and address key social determinants, such as poverty, malnutrition, and HIV co-infection, which fuel the epidemic.
The fight against TB in Africa is far from over. It is time for African governments to take full ownership of TB control efforts, prioritize long-term health investments, and ensure that no one is left behind in the fight against this preventable and treatable disease. Without urgent investment, political commitment, and African-driven strategies, millions will continue to suffer.