WHO and the Stop TB Partnership have forecasted approximately 1.4 million additional deaths between 2020 and 2025

Two-thirds of all tuberculosis-related deaths are concentrated in just eight countries with India (33%), Indonesia (10%), and Nigeria (8%) bearing the heaviest burden, says the updated report from The Lancet Commission on Tuberculosis.

The report highlights that progress towards ending tuberculosis has been inconsistent across different nations since 2018, attributing it to a complex interplay of political, societal, scientific, and strategic factors. Countries are ranked in terms of tuberculosis-related deaths, with India topping the list in 2021 and Zimbabwe having the lowest number.

It says progress towards ending tuberculosis has been minimal in some countries and substantial in others since 2019. This discrepancy has resulted from a mix of political, societal, scientific, and strategic factors.

“Since this Commission’s last report in 2019, global progress towards ending tuberculosis has slowed because of the COVID-19 pandemic, but a newly expanded set of tools and strategies offers hope for a brighter future,” the report reads. “The UN High Level Meeting (HLM) on tuberculosis in September, 2023, provides a unique opportunity to galvanise global efforts and draw attention to new approaches that make ending tuberculosis more achievable than ever before.”

“However, we must act quickly, as further delays will only result in more needless suffering and loss of life. An equity-focused human rights agenda, coupled with efforts to secure universal health coverage, is essential to end tuberculosis. The COVID-19 pandemic has also underscored the importance of optimising coordination between pandemic preparedness and tuberculosis elimination efforts,” it adds.

WHO and the Stop TB Partnership forecasted approximately 190 000 additional tuberculosis deaths in 2020 and approximately 1.4 million additional deaths between 2020 and 2025, with the latter projected to worsen for each month taken to restore health services,” the report says.

Among the highest tuberculosis burden countries, there was a deterioration in the rate of decline in tuberculosis mortality, with many high-burden countries seeing an increase in tuberculosis mortality in 2020 and 2021 for the first time in a decade.

The report points out that health system frailties, little investment in tuberculosis programmes, and over-reliance on one-size-fits-all approaches have all contributed.

“Especially for the highest burden countries, the biggest challenge to ending tuberculosis has been insufficient case finding and diagnosis,” the report adds.

In 2020, the COVID-19 pandemic undid years of reductions in tuberculosis mortality rates. For the first time in nearly two decades, global tuberculosis deaths stopped declining with more than a third of people with tuberculosis remaining undiagnosed and untreated. COVID-19 quickly and substantially disrupted tuberculosis responses as diagnostic infrastructure was diverted away from tuberculosis programmes, and shutdowns and lockdowns led to reduced access to tuberculosis treatment services.

The updated report highlights lessons learned from the successes and failures of the COVID-19 response and the intersecting priorities of pandemic preparedness with tuberculosis response efforts and the universal health coverage agenda, including a shared vision to strengthen multilateralism across political, cultural, institutional, and financial dimensions.

“Can we build a tuberculosis-free world? Yes. Will we? Each country’s answer will depend on the decisions made by leaders and institutions at all levels, in all sectors, and across all parts of society. The leadership of national tuberculosis programmes and the adequacy of the resources at their disposal will be of the utmost importance,” the report explains.

The countries have been asked to commit to expanding universal access to molecular assays as the standard of care for diagnosing tuberculosis everywhere and ensuring universal access to shorter, less toxic, oral regimens for both drug-sensitive and drug-resistant tuberculosis.

The countries have also been asked to implement the social protection strategies necessary to ensure all people seeking or receiving tuberculosis care can access diagnostic and treatment services without risk of catastrophic cost, including in the private health sector.

The report urges efforts to “continue to hold governments in high-burden countries accountable to ensure they commit financial resources and political action to driving change.”

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