Tuberculosis (TB) is an airborne infection that many people think of as a disease of the past. But after decades of steady decline in high-income countries such as the UK and the US, the number of people diagnosed with TB is climbing.
In England, the UK Health Security Agency reported that TB diagnoses increased by 13 per cent in 2024 compared with the previous year, to 5,480 people.
This number is still small relative to other high-burden countries, and England remains, just, under the World Health Organization (WHO) threshold for ‘low incidence’ status – 10 cases per every 100,000 population.
But these figures, and similar trends in the US, are a clear sign that previous progress has stalled and we’re no longer on the right trajectory for ending TB.
Wake-up Call
So is TB really making a comeback? The short answer is that the disease never really went away.
In fact, TB is the world’s deadliest infectious disease, killing about 1.23 million people in 2024 alone. That’s more than HIV and malaria combined, and puts TB among the top 10 causes of death worldwide.
WHO reports that more than 10 million people continue to fall ill with TB annually and, shockingly, roughly a quarter of them are never diagnosed or treated. The COVID-19 pandemic disrupted years of hard-won global progress in TB prevention and care, but that doesn’t tell the whole story.
TB is caused by the bacterium Mycobacterium tuberculosis. It spreads through the air when a person with infectious TB in their lungs coughs, sneezes, sings or even talks.
Classic symptoms of TB are a cough that lasts more than three weeks, fever, night sweats, weight loss and fatigue. Most people with TB have it in the lungs, but it can affect any organ in the body.
Though we’ve had effective treatment for TB for decades, it’s far from perfect. Curing it requires months of antibiotics, and access to them can be a challenge depending on where you live. While the Bacillus Calmette–Guérin (BCG) vaccine protects young children from severe forms of TB, it doesn’t reliably prevent the infectious lung disease that drives transmission, especially in adults.
It’s also worth noting that most people who inhale the bacteria don’t become sick. An estimated one-quarter of the global population is infected with TB, but their immune system keeps it dormant. Latent TB, as this is known, can be detected with a skin or blood test, and preventive antibiotics are often offered to stop it from becoming an active disease.
When exposed, those who are at the highest risk of developing TB are people with weakened immunity. This includes people with HIV or diabetes, as well as people undergoing cancer treatment, or on certain drugs used to treat illnesses such as rheumatoid arthritis.
Skewed burden
TB is closely tied to poverty and to the conditions in which people live and work. Crowded or poorly ventilated housing, homelessness, low income and health risks such as under-nutrition, diabetes, smoking and heavy alcohol use can all increase a person’s vulnerability.
People in disadvantaged communities are more likely to be exposed and less likely to be diagnosed early, meaning that generally they suffer from worse treatment outcomes. Social stigma, gaps in health systems and misattributed symptoms can also further delay care.
That’s why people-centred models, which combine medical treatment with psychological, economic and social support, are increasingly recognised as essential to tackling TB effectively.
TB affects people of all sexes and genders, but data from the WHO show that men aged 15 and older bear a disproportionately high burden. In 2024, an estimated 54 per cent of people who developed TB were men, compared with women (35 per cent) and children and adolescents (11 per cent).
Men also face greater barriers to diagnosis and treatment and have worse outcomes – for example, a 45-per-cent higher death rate after starting treatment, compared with women.
These disparities are driven by a mix of factors, from higher rates of smoking and alcohol use among men, to occupational risks and gender norms that discourage seeking care.
Women and people with diverse sexual orientations and gender identities also face distinct challenges. A gender-responsive, people-centred approach is therefore critical if the goal of ending TB for everyone is to be achieved.
Turning points
The good news is that science is making some of the biggest advances against TB in decades – from faster diagnosis to shorter and less toxic treatment regimens and promising vaccines.
Rapid molecular tests such as Xpert MTB/RIF and Truenat can detect TB and drug resistance within hours rather than weeks, and artificial intelligence-assisted chest X-rays are improving early detection in areas without access to radiologists.
Treatment regimens have also become shorter and safer. It’s now possible to treat TB infection in one month, some forms of drug-susceptible TB in four months and drug-resistant TB in six months.
Vaccine research is advancing too, with candidates such as M72/AS01E in late-stage clinical trials. Together, these advances mark major progress, but ensuring that everyone can benefit from them, especially in low-resource settings, remains a big challenge.
Studies from the Centre for Tuberculosis Research in Liverpool have shown that stigma, discrimination, poverty, gender and structural barriers all influence the journey people with TB take.
To ensure no one with TB gets left behind, understanding how people experience the disease and the barriers and facilitators in reaching those with TB is essential.
To bring about people-centred TB treatment, governments, researchers and TB-affected communities are working together on models that combine clinical care with community education, mental health support and financial or nutritional assistance. But there’s still a long way to go.
The UK’s recent pledge of £850m to the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2027–29 reflects this commitment, contributing to an effort the Fund estimates has saved 70 million lives since 2002.
It should be acknowledged, though, that the pledge represents a 15-per-cent cut from the previous financial cycle, adding to the deep realities of development funding cuts and the impact on the progress in the fight against TB.
Cuts to international aid have weakened TB programmes in the countries that carry the highest burden and this will have consequences that will inevitably ripple across borders. Sustained political will and investment in locally appropriate, people-centred approaches are essential if we are to reach the goal of ending TB for all.
So, should you be worried about catching TB? If you live in the UK, generally no. TB is still uncommon and, for most people, the risk of infection is very low unless you have close, prolonged contact with someone infectious.
If you have a cough that lasts more than three weeks – especially if it comes with other symptoms such as fever, weight loss or night sweats – contact your doctor.
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