After two years of COVID‑19 related-disruptions, there was a major recovery in the number of people diagnosed with Tuberculosis (TB) and treated in 2022, however TB remained the second leading cause of death from a single infectious agent in 2022, after COVID‑19 in Asia-Pacific. In 2022, there were 7.5 million incident (new and relapsed) TB cases worldwide – the highest number since WHO began global TB monitoring in 1995, which probably includes a sizeable backlog of people who developed TB in previous years, but whose diagnosis and treatment was delayed by COVID-related disruptions, leading to an estimated 1.3 million deaths globally (WHO, 2023[1]). In 2022, 55% of people who developed TB were men, 33% were women and 12% were children (aged 0‑14 years). Most cases of TB are curable if diagnosed early and the appropriate treatment is provided, therefore curtailing onward transmission of infection.
TB was declared a global health emergency by the WHO in 1993, and the WHO-co‑ordinated Stop TB Partnership set targets of halving TB prevalence and deaths by 2015 compared with a baseline of 1990. The WHO’s End TB Strategy (post‑2015) which followed the Stop TB Strategy aims at ending the global TB epidemic by 2035, in line with the Sustainable Development Goals (Sharma, 2017[2]).
A high-level meeting was held in September 2023, alongside high-level meetings about universal coverage and pandemic prevention, preparedness and response (PPPR). The political declaration includes new commitments and targets for the period 2023‑27 to accelerate progress to end TB. The new targets include reaching 90% of people in need with TB prevention and care services; using a WHO-recommended rapid test as the first method of diagnosing TB; providing a health and social benefit package to all people with TB; ensuring the availability of at least one new TB vaccine that is safe and effective; and closing funding gaps for TB implementation and research by 2027. (WHO, 2024[3])
In Asia-Pacific, TB mortality rates were high in Myanmar, Nepal and Indonesia with 50 deaths or over of people without HIV per 100 000 populations. TB mortality rates among people with HIV is highest in Myanmar at about 11 per 100 000 populations, (Figure 3.24, left panel).
South-East Asia accounted for 46% of the estimated TB cases globally in 2022, more than any other WHO region. India (27.0% of TB cases globally), Indonesia (10%), China (7.1%), the Philippines (7.0%), Pakistan (5.7%), and Bangladesh (3.6%) were amongst the most affected countries and territories in 2022 (WHO, 2023[1]).An incidence rate higher than 500 cases per 100 000 population was estimated for the Philippines and DPRK, while for Australia and New Zealand less than 10 incident cases per 100 000 population were estimated (Figure 3.24, right panel).
High-quality TB services have expanded, and many cases are treated, reaching the treatment success rate for new TB cases of more than 85% in many Asia-Pacific countries and territories in 2021 (Figure 3.25, left panel). Nevertheless, Fiji reports a low treatment success rate at 56%. In countries and territories where TB predominantly affects older people -such as Japan and Hong Kong (China), treatment success rate was lower than 75% (Teo et al., 2023[4]). Globally the treatment success rate was 86% for those enrolled in 2020 (the same level as in 2019) and 88% for those enrolled in 2021. This shows that, despite the many disruptions caused by the COVID‑19 pandemic, the quality of treatment for those diagnosed with TB was maintained in 2020 and 2021 (WHO, 2024[3]; Oh et al., 2024[5]).
The Asia-Pacific region is rising to the challenges presented by TB. In a large part of the countries and territories, case notification rates have declined from 2015 to 2022 (Figure 3.25, right panel). However, countries and territories like Indonesia, Lao PDR, Fiji, Philippines, India, Singapore, Pakistan, Bangladesh, Thailand, Papua New Guinea are showing upward trends. Some countries in the Asia-Pacific region still face important challenges in TB control, including providing services to those in greatest need, especially the poor and vulnerable and there are still major economic and financial barriers to accessing and completing TB treatment, which need to be addressed through faster progress towards UHC and better levels of social protection. TB-HIV co‑infection, the spread of drug-resistant strains, a sizeable proportion of TB-affected population facing catastrophic costs due to TB, funding gaps and the need for greater technical expertise all remain threats to progress (WHO, 2016[6]; WHO, 2019[7]). Concerning drug-resistant TB (MDR/RR-TB), Despite increased testing coverage and an increase in the absolute number of people tested, the number of people detected with MDR/RR-TB was lower in 2022 (i.e. 4.4% of those tested) than in 2019 (5.6% of those tested) (WHO, 2023[1]).
