Powering on to a TB-free society

Professor Rubeshan Perumal

TUBERCULOSIS (TB) is an ancient and deadly infectious disease that still claims over 1 million lives every year. However, thanks to significant investments, medical advancements, and global political commitment, we now have the tools to prevent TB in at-risk individuals and effectively treat the disease when it is detected early.

With widespread adoption of these diagnostic and therapeutic tools, we should be making progress toward a world free of TB. Unfortunately, the reality is that the number of new TB cases continues to rise each year. TB remains the leading cause of death from a single infectious disease worldwide, and we are currently far off track from the goal of ending TB as a public health threat by 2035. Clearly, there is still much work to be done in the fight against this deadly disease.

A significant number of people with TB in our communities remain undiagnosed because we rely on individuals developing symptoms—such as a persistent cough or night sweats—and seeking care at health facilities for testing. For various reasons, many people with these symptoms are reluctant to seek medical attention, and others may have TB but show no symptoms at all (asymptomatic TB). In both cases, TB continues to spread within homes, communities, and workplaces, as individuals with undiagnosed TB unknowingly transmit the disease. To break the cycle of transmission, we must take a more proactive approach to TB detection. This means reaching out within communities to identify close contacts of known TB cases and actively screening individuals who may not even be aware they have the disease.

We must also recognise the significant impact of social factors on TB risk and outcomes, including homelessness, food insecurity, substance use, and overcrowding. These social and economic challenges make it harder for people to access care, attend follow-up appointments, complete the lengthy six-month treatment, and take necessary precautions to prevent spreading the disease. The health system alone cannot address these issues. A comprehensive, society-wide approach is needed, one that delivers person-centred, needs-based care across various sectors. Communities that provide universal access to diagnostic tests and medicines, implement strong public health measures to trace contacts, offer social protection, organise community support, and ensure favourable economic conditions have seen a marked reduction in their TB burden. It is clear that tackling TB effectively requires not only improved health services but also progress in addressing the broader social and economic challenges facing our communities.

We must continue to invest significantly in both financial and human resources for medical research to overcome the ongoing and future challenges in eliminating TB. As the saying goes, "prevention is better than cure," and the lack of a highly effective TB vaccine remains a major gap in our public health efforts against the TB pandemic. There has been substantial investment in developing TB vaccine candidates, and for the first time in over a century, several promising candidates are advancing through clinical trials. The bacillus Calmette-Guérin (BCG) vaccine, given to infants, is effective in preventing the most severe forms of TB, like meningitis, but has shown limited success in providing long-lasting protection against pulmonary TB, the most common form in adults. An affordable, effective TB vaccine that is distributed equitably across the global population and widely accepted could significantly accelerate our progress toward a TB-free world.

Finally, we need a deeper commitment to global solidarity in the fight against TB—an infectious disease that knows no borders, regional blocs, or geopolitical divisions. Ignoring TB epidemics in any part of the world delays our recognition of the universal threat posed by a disease that can easily spread across borders due to global human mobility and interconnectedness. Additionally, poor management of TB has contributed to the emergence of increasingly resistant forms of the disease, with recent reports of TB cases completely resistant to all available medications. The continued spread of drug-resistant TB strains poses an existential threat to even the most advanced and well-resourced TB programs, as there are currently no diagnostic or treatment options for the most resistant forms. In short, without global solidarity and a unified effort to eradicate TB everywhere, there is little hope of eliminating it anywhere.

South African scientists have been at the forefront of the technological innovations necessary to end TB, and the South African TB Control Programme has been a leader in implementing evidence-based interventions to reduce the TB burden. As we observe World TB Day 2025, we honour the millions of lives lost to this preventable and treatable disease. We stand in solidarity with the millions who continue to fall ill with TB each year, and we recognise the healthcare workers, medical researchers, community members, and civil society organisations who boldly envision and fight for a world free from the threat of TB.

The World TB Day 2025 slogan, ‘Yes! We can end TB: Commit, Invest, Deliver,’ is both hopeful and instructive. It calls for renewed global solidarity, stronger political will, increased funding for TB research and care, and the urgent implementation of evidence-based, person-centred interventions to eliminate TB once and for all.

DAILY NEWS