Tuberculosis remains one of the deadliest infectious diseases in the world. Although it is both preventable and curable, it still causes more than 1.2 million deaths every year. In Europe—where many might think it belongs to the past—the reality is very different. In 2023, nearly 39,000 cases were reported in EU and European Economic Area (EEA) countries, and the most concerning trend is the rise of drug-resistant forms. These variants are harder and more expensive to treat, and in some countries, cure rates remain below 40%, far from the 90% target recommended by the World Health Organization (WHO).
In Spain, TB cases increased by 10% in 2024 compared to the previous year, continuing the upward trend that began in 2021. Although some progress has been made since 2015, the country is still far from meeting the international targets set by the End TB Strategy, which aims to reduce incidence by 50% by 2025 and by 80% by 2030.
Against this backdrop, this week we met in Brussels with representatives from the European Commission and Parliament, Médecins Sans Frontières (MSF), and several civil society organizations to discuss this situation and review the findings of MSF’s report Bridging the Gap: Securing access to essential TB medicines in the EU and EEA. The report, published by MSF, presents concrete data and examples showing that Europe is failing to ensure equitable access to essential TB medicines.
Effective treatments exist, yet they often do not reach those who need them. In Europe, essential TB medicines are still missing in several countries. Those that are available are prohibitively priced, and their distribution relies on fragmented supply systems that cause delays and inequalities. In some cases, a six-month treatment for drug-resistant tuberculosis can cost more than 45,000 euros per person—prices that prevent European health systems from maintaining sufficient stockpiles and ensuring the continuity of treatments.
According to our research, in Spain the public price of this six-month treatment regimen recommended by the WHO—known as BPaLM (bedaquiline, pretomanid, linezolid and moxifloxacin)—reaches €58,000. In contrast, LMICs can access the same regimen for less than €250. This disproportionate gap represents an unacceptable barrier to a treatment proven to be more effective and significantly shorter than traditional DR-TB regimens.
“We’re witnessing a public health crisis that’s far from belong to history. Yet the barriers to accessing tuberculosis essential medicines are old: monopolies, high prices, lack of transparency, and weak public safeguards in pharmaceutical policy,” said our colleague Jaime Manzano.
We also discussed how, despite significant public investment in research and development, the benefits of these advances are not reflected in improved access. Medicines such as bedaquiline and pretomanid, developed with public funds, remain protected by patents or are marketed at unaffordable prices. Moreover, European regulatory frameworks are not adapted to the realities of diseases such as tuberculosis, which require flexibility, collaboration, and a public health–oriented approach rather than one driven by market interests.
However, we also saw examples showing that progress is possible. Poland, which faced a rise in TB cases following the arrival of refugees from Ukraine, has taken important steps to update its national policies and enable safer and more effective outpatient treatment. This demonstrates that with political will and international cooperation, it is possible to save lives and strengthen health systems.
Photographs: Shailly Gupta, MSF Access
Spain has also made progress by using the Global Drug Facility (GDF) in 2023 to procure pediatric formulations. This global pooled procurement mechanism allows countries to access TB medicines and diagnostics at much lower prices and has been a milestone in improving global access. Although available to all countries, the GDF is mainly used by low- and middle-income countries (LMICs). This mechanism has not only helped reduce the prices of medicines that remain unaffordable within the EU, but also contributed to preventing shortages by consolidating demand across multiple countries. In Spain, as in other European countries, shortages of essential TB medicines are a recurrent problem affecting hundreds of patients.
“While effective medicines to treat and prevent TB have been available globally for years, it is preposterous that people with TB in the highly developed EU/EEA region continue to face delayed, interrupted or suboptimal treatment because essential medicines are either exorbitantly priced, stuck in fragmented supply chain systems, or simply not registered in countries,” said Joanna Ładomirska, Medical Coordinator for MSF in Poland.
Europe now has both the opportunity and the responsibility to change this situation. The ongoing revision of the EU pharmaceutical legislation and the new Critical Medicines Act could be valuable tools—if they are truly oriented toward the public good. To make this happen, stronger cooperation among member states, transparent medicine pricing policies, and the use of available regulatory flexibilities are essential to ensure that medicines reach those who need them.
“Addressing the growing resurgence of TB in Europe is only possible with strong political will”, said Dr Marc Biot, Regional Coordinator, MSF Access. “It’s time for Europe to revive its fight against this preventable yet deadly disease, and guarantee access to the most advanced and effective treatment for everyone who needs it”.
Tuberculosis has not disappeared and continues to affect thousands of people across Europe. Overcoming inequities in access and prioritising public health over commercial interests remains an urgent task that can no longer be postponed.
