World will miss ambitious TB targets without urgent technological breakthroughs

The world will not hit ambitious targets to cut its deadliest infectious disease without urgent technological breakthroughs, an annual survey of tuberculosis has found.

The bacterial disease killed an estimated 1.25m people last year, slightly down from the year before, but it reclaimed its top slot as the planet’s biggest infectious killer, after three years behind Covid-19.

TB rates across the world did show signs of plateauing, the World Health Organization (WHO) report said, but there had been a worrying sharp rise in cases across the Americas.

Experts said it was a “particular concern” that the incidence rate had risen a fifth across North and South America since 2015, while it had largely fallen elsewhere.

Some 10.8m people fell ill with TB in 2023, up from 10.7m the year before, though the overall incidence rate was almost unchanged at around 134 new cases per per 100, 000 people.

Those figures mean the world appears set to fall well short of goals to bring sharp reductions in TB deaths and infections over the next decade.

Officials aimed to cut deaths to a quarter of their 2015 level by 2025. So far they have fallen 23 per cent. TB incidence was supposed to be cut by half over the same period and has only fallen by eight per cent so far.

The targets “cannot be met without intensified research and innovation”, the report concludes.

“Major technological breakthroughs are urgently needed to accelerate the annual decline in the global TB incidence rate.”

“Priorities include new vaccines to reduce the risk of infection, new vaccines or preventive drug treatments to cut the risk of TB disease in people already infected, rapid diagnostic tests for accurate detection of TB disease at the point of care, and simpler, shorter treatments for TB disease.”

TB researchers are excited by a healthy pipeline of new vaccines under development to supplement the century-old ‘BCG jab’, but each faces years of clinical trials.

One of the most promising candidates, called M72/AS01E, may be able to save millions of lives in the coming year, but trials which began this year may stretch to 2029.

However funding for new research and vaccines was lacking, the report said, with donors pledging only a fifth of what was needed.

The report showed a mixed picture of the toll of the disease around the world, with developing and middle income countries hit hardest. The most vulnerable are the poor, the hungry and those on drugs.

Five countries account for nearly three-in-five of the worldwide total of cases: India (26 per cent), Indonesia (10 per cent), China (6.8 per cent), the Philippines (6.8 per cent) and Pakistan (6.3 per cent).

Rates are falling in most regions of the world, except for the Americas and the Western Pacific.

Earlier this year, a study led by researchers from California’s Stanford University found that booming prison populations across Latin America were driving TB rates in the region.

The number of people locked in the region has jumped four-fold in the past 30 years and the study found prison, with its overcrowding and poor ventilation, was responsible for a third of all TB cases.

America’s Centres for Disease Control earlier this year reported that after decades of declines, rates in the US had started to creep back up after the pandemic and had risen back to 2013 levels.

The worst hit were people born outside the country, Black people and Native Americans.

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