On the eve of World Tuberculosis Day (TB), March 24, the World Health Organisation (WHO) issued a grave warning about the future of worldwide tuberculosis care.  As tuberculosis remains the world's deadliest infectious disease, killing over 1 million people each year, the appeal for immediate investment comes at a time when significant financial cuts and growing global problems threaten to reverse decades of progress.

Since 2000, global attempts to eliminate tuberculosis have saved an estimated 79 million lives. However, dramatic cuts to global health spending are jeopardising these gains. Rising medication resistance, notably in Europe, and ongoing conflicts in the Middle East, Africa, and Eastern Europe have exacerbated vulnerabilities in areas where tuberculosis is most common. Early reports to WHO show that major disruptions in TB services are occurring in 27 high-burden countries. The consequences are most prominent in Africa, with similar disturbing repercussions documented in Southeast Asia and the Western Pacific.

The situation is complex: human resource shortages are jeopardising service delivery, diagnostic services are badly disrupted, delaying detection and treatment, and collapsing data and surveillance systems are hampering effective disease management. Furthermore, community participation activities, such as active case detection, screening, and contact tracing, have weakened, raising transmission risks. Nine countries have reported that inadequate TB medicine procurement and supply chains endanger treatment continuity and patient outcomes.

Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, expressed concern that funding cuts are jeopardising access to services for the prevention, screening, and treatment of tuberculosis (TB). But we cannot abandon the concrete pledges made by world leaders at the UN General Assembly just 18 months ago to speed efforts to eliminate tuberculosis. WHO is dedicated to collaborating with all donors, partners, and affected countries to reduce the effect of funding reduction and develop innovative solutions."

Funding limits exacerbate the crisis. In 2023, only 26% of the US$22 billion required yearly for TB prevention and care was accessible, and TB research is in a situation of emergency, getting barely one-fifth of the US$5 billion objective set in 2022. These gaps substantially impede progress in diagnostics, therapies, and vaccine development. While WHO leads efforts through the TB Vaccine Accelerator Council, these projects are susceptible without immediate funding backing.

In response to the rising crisis, the WHO Director-General and the Civil Society Task Force on Tuberculosis issued a joint statement listing five important goals for stabilising the global TB response. These include responding quickly to TB service disruptions; securing long-term domestic funding; ensuring access to critical TB services, such as lifesaving drugs, diagnostics, and treatment; establishing or revitalising national collaboration platforms; and improving monitoring and early warning systems to detect disruptions quickly. 

Dr. Tereza Kasaeva, Director of WHO's Global Program on TB and Lung Health, emphasised the need for immediate action to maintain global TB progress and prevent life-threatening reverses. Investing in tuberculosis eradication is not only a moral imperative but also an economic necessity—every dollar invested in prevention and treatment generates an estimated US$43 in economic gains.

To address resource restrictions, WHO has recently issued new technical guidelines supporting the integration of tuberculosis and lung health into primary care. This method focusses on prevention, early detection of tuberculosis and comorbidities, and enhanced patient follow-up while also tackling common risk factors, such as overcrowding, tobacco use, malnutrition, and environmental pollutants..

Financial and systemic failure can quickly undo decades of public health progress, as the current TB care crisis soberingly reminds us. The WHO's call for action emphasises global unity and bold policymaking. Without prompt, coordinated action and sustained investment, the world stands at risk of losing headway in the fight against tuberculosis while simultaneously confronting a larger health security problem.