Tuberculosis (TB) remains the world’s leading cause of death from a single infectious agent. Each year, millions of people fall ill and die despite the existence of effective tools to prevent and treat the disease. On World TB Day, current data serve as a stark reminder that the epidemic is far from under control and that progress toward TB elimination is moving slower than anticipated.
In 2024, an estimated 10.7 million people developed TB, and 1.23 million died from the disease. These figures underscore a significant service coverage gap. While 8.3 million people were diagnosed and put on treatment, more than one in five remained outside the health system that year. The situation is even more critical for drug-resistant TB (DR-TB). In 2024, over 164,000 people started treatment—a figure that remains woefully inadequate to meet the actual burden of disease.
TB, Inequality, and Global Crises
TB thrives in settings of high vulnerability, where factors such as poverty, undernutrition, overcrowding, and barriers to healthcare access increase transmission risks and complicate diagnosis and treatment adherence. Furthermore, armed conflicts and protracted crises disrupt continuity of care and worsen the conditions necessary to control the disease.
Forced displacement exacerbates these barriers. In 2024, over 123 million people were displaced from their homes; many face immense challenges in maintaining continuous access to health services or completing long-term treatment regimens, increasing the risk of transmission and complications.
Situations in Gaza and Ukraine reflect this reality. The destruction of health infrastructure and ongoing instability hinder the monitoring of patients, increasing the risk of transmission and the emergence of drug-resistant forms. This is further compounded by the climate crisis. Extreme weather events, food insecurity, and strained health systems limit the capacity to prevent and treat the disease. In response, policies must be enacted to guarantee barrier-free access to care and ensure treatment continuity, even in crisis settings.
Europe is not immune. In 2024, more than 19,000 people died from TB in the European region and neighboring areas, with tens of thousands of cases reported. Additionally, drug-resistant strains account for up to 55,000 annual cases in this region—a form of the disease that complicates treatment and requires sustained medical attention.
Decisions Shaping Access to Care
In Spain, the decline in TB cases has stalled in recent years. According to the National Epidemiological Surveillance Network (RENAVE), 4,624 diagnoses were reported in 2024—a 10% increase over the previous year. This trend moves the country away from the trajectory required for elimination and highlights a core challenge: effective access to WHO-recommended treatments.
A major breakthrough is the BPaLM regimen, a four-drug combination (bedaquiline, pretomanid, linezolid, and moxifloxacin) that allows DR-TB to be treated in just six months with improved clinical outcomes. However, access is heavily restricted by price. In Spain, a full course exceeds €57,900 per patient, whereas the same regimen can be procured for approximately €240 through international mechanisms like the Stop TB Partnership’s Global Drug Facility (GDF).
Barriers are not limited to cost; they include regulatory bottlenecks and limited availability. Some key medicines are not marketed locally or require individual authorizations for use, creating administrative burdens and potential delays. Furthermore, supply chain disruptions have affected essential drugs, jeopardizing treatment continuity.
These limitations illustrate how financing, regulation, and pricing decisions dictate access to medicines. In Europe, independent national negotiations and a lack of transparency in agreements hinder progress. In practice, this results in fragmented pathways and difficulties in maintaining care, even in consolidated health systems. Similarly, the underutilization of regulatory flexibilities and pooled procurement mechanisms, such as the GDF, exacerbates a problem that currently lacks sufficient political will.
Without Adequate Funding, the Response Weakens
TB diagnosis, treatment, and prevention programs rely heavily on external funding in many countries. The Global Fund to Fight AIDS, Tuberculosis and Malaria concentrates a substantial portion of these resources, financing approximately 73% of the international TB response. In 2024, these programs enabled more than 7.4 million people to receive treatment in high-burden regions.
However, resources are falling short. The Global Fund set a target of US$18 billion for the 2026–2028 period but ultimately secured only US$12.64 billion. This funding gap directly undermines program capacity—from early case detection to ensuring that everyone can access and complete their treatment. In practice, this leads to delayed diagnoses, reduced access, and greater difficulty sustaining prevention efforts.
A Vaccine That Has Yet to Arrive
Improving treatment, diagnosis, and vaccines remains a primary challenge in the fight against TB, but so does ensuring these tools reach those who need them. Initiatives such as Unitaid work toward this goal, driving new solutions and facilitating their integration into health systems.
This gap is particularly visible in pediatric TB. The disease is harder to detect in children, causing many cases to go unnoticed. It is estimated that more than 40% of children with TB are neither diagnosed nor treated each year, a reality that highlights the profound inequities in access to care.
In parallel, several vaccine candidates, such as M72 or the Spanish vaccine MTBVAC, are advancing through late-stage clinical trials and could become available in the coming years. However, their development remains largely dependent on public and philanthropic funding. Because the disease disproportionately impacts low-resource settings and offers limited financial returns for the pharmaceutical industry, insufficient investment may delay both their development and their delivery to those in need.
Therefore, it is essential that equitable global access is integrated from the earliest stages. This involves ensuring these vaccines are available and affordable regardless of the country. Public R&D funding programs, such as Horizon Europe or those led by Spain’s Ministry of Science, should incorporate binding access conditions to ensure a public return on investment.
Securing these resources will determine not only if these vaccines arrive in time, but who will benefit from them. Investing in TB does more than reduce disease burden; it strengthens health systems. Every dollar invested can yield up to $46 in economic and social returns.
As bestselling author John Green noted, there is a particular privilege in believing that history belongs to the past. The TB response is the nexus of today’s most urgent global agendas. It provides a stark illustration of how the social determinants of health and structural injustices impact well-being. Furthermore, there is growing evidence that TB is a climate-sensitive condition that must be included in adaptation and mitigation strategies, as well as their financing mechanisms. Additionally, restrictive migration policies hinder the response by limiting healthcare access and obstructing dignified reception conditions.
Today, more than ever, tuberculosis sits at the heart of the debate over the society we want to build and the decisions that make it possible.
