The global battle against tuberculosis (TB) is at a critical juncture. While significant progress has been made in reducing TB cases and deaths over the past decade, shrinking international health funding now threatens to reverse these hard-won gains, according to a major analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023.

The study, which assessed the burden of tuberculosis across 204 countries and territories, warns that despite encouraging declines in TB incidence and mortality, progress remains uneven and fragile, particularly in the fight against multidrug-resistant tuberculosis (MDR-TB) and HIV-associated TB.

Researchers estimate that 9.11 million people developed tuberculosis worldwide in 2023, while the disease claimed 1.22 million lives, making TB the world's deadliest infectious disease caused by a single pathogen. The illness was also responsible for 54.6 million disability-adjusted life years (DALYs), highlighting its enormous health and socioeconomic impact.

The report reveals that HIV-related tuberculosis accounted for 781,000 new cases and 210,000 deaths, while multidrug-resistant TB (MDR-TB), one of the most difficult forms of the disease to treat, resulted in 466,000 new infections and 102,000 deaths during the year.

Encouragingly, the study found that between 2015 and 2023, global TB incidence declined by 19.2 per cent, while TB-related deaths fell by 22.6 per cent. However, these gains were far more pronounced for drug-susceptible TB than for MDR-TB, underscoring the growing challenge posed by antibiotic resistance.

According to the researchers, Sub-Saharan Africa and South Asia continue to bear the highest tuberculosis mortality burden, while progress has remained limited in parts of Latin America and the Caribbean, where reductions in TB incidence and deaths have largely stagnated over the past two decades.

Beyond medical treatment, the study highlights the critical role of lifestyle-related risk factors in driving the global TB epidemic. Researchers estimate that eliminating smoking, harmful alcohol consumption, and high fasting plasma glucose could have reduced global TB deaths to 768,000 in 2023 and substantially lowered the disease burden. The same interventions could also significantly reduce deaths and disability caused by multidrug-resistant tuberculosis.

The findings come at a crucial time as countries strive to achieve the World Health Organization's End TB Strategy, which aims to reduce TB deaths by 95 per cent and TB incidence by 90 per cent between 2015 and 2035.

However, the researchers caution that recent reductions in global health financing could jeopardize these ambitious goals. They warn that persistent HIV infection, the growing threat of drug-resistant tuberculosis, increasing exposure to preventable risk factors, and financial uncertainty are creating a fragile public health landscape that could undermine future progress.

The study concludes that sustained political commitment, stronger investment in TB control programmes, and intensified efforts to prevent drug resistance and address modifiable risk factors will be essential if the world is to stay on track towards eliminating tuberculosis as a major public health threat.