Why TB Remains The World’s Deadliest Infectious Disease Despite Decades Of Progress
By Dr Tara Singh Bam
For decades, the global fight against tuberculosis has focused on finding and treating people who fall ill.
Millions of lives have been saved, yet one uncomfortable reality remains: TB continues to be the world’s deadliest infectious disease.
This raises a critical question.
If countries have expanded diagnosis and treatment and met key programme targets, why are we still not on track to end TB?
The answer is simple but significant: treating TB is essential, but treatment alone cannot end the epidemic.
We have become better at treating the disease, but not nearly good enough at preventing people from developing it.
Millions continue to fall ill with TB every year because the underlying conditions that fuel the disease remain largely unaddressed.
Prevention Is the Missing Link
Many new TB cases are linked to preventable or manageable risk factors, including tobacco smoking, harmful alcohol use, undernutrition, diabetes and HIV.
In 2024 alone, an estimated 970,000 TB cases globally were attributable to undernutrition, 930,000 to diabetes, 740,000 to alcohol use disorders, 700,000 to smoking and 570,000 to HIV infection.
Consider a person living with diabetes who also smokes. Treating that individual for TB without supporting smoking cessation or effective diabetes management leaves the person vulnerable to further illness.
Meanwhile, many others continue to develop TB because the same underlying risks persist.
Health Systems Must Act Before People Fall Ill
Most TB programmes remain reactive. Intervention often begins only after a person becomes sick.
By then, the disease may have already spread to family members, colleagues and others in the community.
A person with a persistent cough, for example, may wait months before seeking medical attention. During that period, they could unknowingly transmit TB to several people.
More proactive screening and earlier detection could prevent such transmission and save more lives.
Yet screening strategies in many countries remain limited. Passive case finding and targeted screening among selected high-risk populations, including people living with HIV, refugees and prisoners, are important but insufficient.
Countries seeking to eliminate TB must consider broader, systematic screening in high-burden communities, alongside stronger contact investigation and preventive treatment.
Poverty and Inequality Continue to Fuel TB
TB does not exist in isolation. It thrives where there is poverty, overcrowded housing, poor nutrition and limited access to healthcare.
Even when diagnosis and treatment are free, patients often face significant indirect costs, including transportation, loss of income and food insecurity.
A daily wage worker, for instance, may delay visiting a clinic because doing so means losing a day’s income. That delay can worsen the disease and increase the risk of transmission.
This is why universal health coverage is critical to ending TB.
No one should face financial barriers to accessing diagnosis, treatment, preventive therapy, nutritional support or care for related conditions such as diabetes and HIV.
Local Leadership Can Change the Story
National governments make policies, but implementation often happens at the local level.
Mayors and other local leaders can play a decisive role by prioritising TB in development plans, mobilising resources, strengthening screening and prevention, improving nutrition and tobacco control, coordinating action across sectors and ensuring equitable access to healthcare.
TB elimination cannot remain the responsibility of health ministries and TB programmes alone.
Funding Must Go Beyond Treating Disease
Prevention remains underfunded and fragmented.
Most resources continue to go towards diagnosing and treating people after they become sick, while comparatively less investment is directed towards preventing new infections and tackling the factors that drive TB.
Effective prevention must include tobacco control and cessation services, reduction of harmful alcohol use, diabetes prevention and management, HIV prevention and treatment, nutritional support and TB preventive treatment for eligible populations.
Countries must also rethink how they raise and allocate resources.
Health taxes on tobacco, alcohol and sugar-sweetened beverages can generate revenue while reducing major TB risk factors.
Increasing tobacco taxes, for example, can reduce smoking prevalence while generating additional government revenue that could be invested in TB prevention, primary healthcare and universal health coverage.
This offers a double dividend for public health.
From Controlling TB to Ending It
Despite progress in diagnosis and treatment, the decline in global TB incidence remains too slow to achieve the goals of the End TB Strategy.
Without stronger prevention measures, countries will continue treating millions of new cases every year rather than significantly reducing the number of people who develop the disease.
Ending TB requires a fundamental shift from a treatment-centred approach to one that is preventive, people-centred and multisectoral.
High-quality diagnosis and treatment must continue, but they should be complemented by coordinated action involving tobacco and alcohol control, diabetes and HIV services, nutrition programmes, universal health coverage, social protection, housing and poverty reduction.
The message is clear: treating TB saves lives today, but preventing TB saves lives today and protects future generations.
The path towards elimination must therefore be built around three priorities: Prevent All TB, Find All TB and Treat All TB.
Prevention must become the first line of defence. Every person with TB should be identified early, and everyone diagnosed should receive timely, high-quality treatment and support.
Achieving this will require strong political leadership beyond the health sector, particularly from local leaders who are uniquely positioned to mobilise resources, coordinate action and build healthier communities.
After decades of fighting TB, the world already knows how to save lives.
The urgent task now is to stop millions more people from developing the disease in the first place.
Dr Tara Singh Bam is Global Health Editorial Advisor for CNS and Honorary Principal Advisor for the Prevent-Find-Treat ALL TB to End TB campaign. He leads Vital Strategies as Asia Pacific Director for Tobacco Control and is Board Director of the Asia Pacific Cities Alliance for Health and Development (APCAT). He is also a former Asia Pacific Director of the International Union Against Tuberculosis and Lung Disease (The Union).
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