Tuberculosis

global TUBERCULOSIS is one of the top

infectious killers
REPORT 2023 in the world

TB SITUATION AND RESPONSE 1.3 MILLION

TB DEATHS INCLUDING
Tuberculosis (TB) is contagious and airborne.
In 2022, TB was the second leading infectious disease killer worldwide,
167 000
DEATHS AMONG
after COVID-19. It was also the leading killer of people with HIV and a major PEOPLE WITH HIV
cause of deaths related to antimicrobial resistance.
TB is also the leading cause
of deaths among people
TB BURDEN with HIV and a major cause
of antimicrobial resistance
In 2022, an estimated 10.6 million (95% uncertainty interval [UI]: 9.9-11.4 million) people related deaths
fell ill with TB worldwide, of which 5.8 million were men, 3.5 million were women and 1.3
million were children. People living with HIV accounted for 6.3% of the total.
The TB incidence rate (new cases per 100 000 population per year) rose by 3.9% IN 2022, AN ESTIMATED
between 2020 and 2022, reversing declines of about 2% per year for most of the past 2
decades. 10.6 million
PEOPLE FELL ILL WITH TB
Globally in 2022, TB caused an estimated 1.30 million (95% UI: 1.18–1.43 million) deaths,
including 167 000 people with HIV. This was down from best estimates of 1.4 million in
both 2020 and 2021 and almost back to the level of 2019.
LIVES SAVED SINCE THE YEAR 2000
Eight countries accounted for more than two-thirds of the global total: India, Indonesia, China,
the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo.
75 MILLION DUE TO GLOBAL EFFORTS TO COMBAT TB

TB CARE AND TREATMENT

DRUG RESISTANT TB REMAINS Only about
Global efforts to combat TB have saved an estimated 75 million lives since the year 2000.
Globally in 2022, the reported number of people newly diagnosed with TB was 7.5 million.
A PUBLIC HEALTH CRISIS
with gaps in detection & treatment
2 IN 5 PEOPLE
This is the highest number since WHO began global TB monitoring in 1995, above the ACCESSED TREATMENT
pre-COVID baseline (and previous historical peak) of 7.1 million in 2019, and up from 5.8 OF THOSE IN NEED
million in 2020 and 6.4 million in 2021.
The cumulative number of people treated between 2018 and 2022 was 34 million,
equivalent to 84% of the 5-year (2018–2022) UN high-level meeting TB target of 40
million. This included 2.5 million children, 71% of the 5-year target of 3.5 million.
There is still a large global gap between the estimated number of people who fell ill with TB
and the number of people newly diagnosed, with approximately 3.1 million people not Major global recovery in the number of people
diagnosed with the disease, or not officially reported to national authorities in 2022, down diagnosed with TB and treated in 2022
from around 4 million in both 2020 and 2021, and back to the pre-pandemic level of 2019.
AFTER 2 YEARS OF COVID-RELATED DISRUPTIONS

DRUG-RESISTANT TB REQUIRED IN 2023

Globally, an estimated 410 000 people (95% UI: 370 000–450 000) developed
US$ 13 BILLION
FOR TB DIAGNOSIS AND CARE
multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) in 2022.
The number of people diagnosed and started on treatment was much lower: 175 650
people in 2022, equivalent to about two in five of those in need and still below the
US$ 5.8 BILLION
WAS AVAILABLE IN 2022
pre-pandemic level of 181 533 people in 2019.
of which 80%
The treatment success rate for drug-resistant TB was 63% globally.
domestic financing
and US$ 1.1 billion
international financing
ADDRESSING THE CO-EPIDEMICS OF TB AND HIV
Among all incident cases of TB in 2022, 6.3% were people living with HIV; this proportion US$ 2 BILLION
has been steadily declining for several years. In 2022, 671 000 people living with HIV fell REQUIRED PER YEAR
ill with TB, with the highest burden in countries in the WHO African Region.
FOR TB RESEARCH
The global coverage of HIV testing among people diagnosed with TB remained high in
2022, at 80%. The global coverage of antiretroviral therapy for people living with HIV
who were newly diagnosed and reported with TB was 85% in 2022.
US$ 1.0 BILLION
FUNDING GAP
TB PREVENTIVE TREATMENT RESEARCH AND INNOVATION
WHO recommends TB preventive treatment for people living with HIV, household The diagnostic pipeline has expanded considerably in terms of the number of tests,
contacts of those with bacteriologically confirmed pulmonary TB, and clinical risk groups products or methods in development. These include molecular tests for the detection of
(e.g. those receiving dialysis). TB disease and drug resistance, interferon-gamma release assays (IGRAs) for the
detection of TB infection, biomarker-based assays for detection of TB disease,
Globally in 2022, TB preventive treatment was provided to 3.8 million people.
computer-aided detection (CAD) for TB screening using digital chest radiography, and a
From 2018 – 2022, 15.5 million people were treated with TB preventive treatment. This new class of aerosol-capture technologies for detection of TB disease.
is only 52% of the UN High Level Meeting TB target of 30 million for the 5-year period
Three M.tb. antigen-based skin tests for detection of TB infection that perform better
2018 – 2022.
than tuberculin skin tests (particularly in terms of specificity) were evaluated and
Most of those provided with TB preventive treatment were people living with HIV. The recommended by WHO in 2022. In 2023, WHO convened a guideline development group
global sub-target of providing TB preventive treatment to 6 million people living with HIV to assess the use of targeted next-generation sequencing for detecting drug-resistant
between 2018 and 2022 was achieved well ahead of schedule. TB directly from sputum specimens. This newly-recommended class of tests is a major
step towards comprehensive drug susceptibility testing.
The cumulative total for household contacts was 4.2 million, equivalent to 17% of the
5-year target of 24 million for the period 2018–2022; this number included 2.2 million There were 16 vaccine candidates in clinical trials by August 2023: four in Phase I, eight
children aged under 5 years (55% of the 5-year subtarget of 4 million) and 2.0 million in Phase II and four in Phase III. They included candidates to prevent TB infection and TB
people in older age groups (10% of the 5-year subtarget of 20 million). disease, and to help improve the outcomes of treatment for TB disease.
In August 2023, there were 28 drugs for the treatment of TB disease in
Phase I, Phase II or Phase III trials. These drugs comprise 18 new chemical entities, two
drugs that have received accelerated regulatory approval, one drug that was recently
UPTAKE OF DIAGNOSTICS, approved by the United States (US) Food and Drug Administration under the limited
NEW DRUGS AND REGIMENS population pathway for antibacterial and antifungal drugs, and seven repurposed drugs.
There are at least 29 clinical trials and implementation research studies to evaluate drug
regimens and models of delivery for TB preventive treatment.
Increasing access to early and accurate diagnosis using a molecular WHO-recommended
rapid diagnostic test is one of the main components of TB laboratory-strengthening efforts
under the End TB Strategy.
The use of rapid diagnostic test remains far too limited. A WHO-recommended rapid UNIVERSAL HEALTH COVERAGE, SOCIAL
molecular test was used as the initial diagnostic test for only 47% of the 7.5 million
people newly diagnosed with TB in 2022, up from 38% in 2021 and 33% in 2020.
DETERMINANTS AND MULTISECTORAL ACTION
By the end of 2022, 40 countries had started to use the new 6-month BPaLM/BPaL
Progress towards universal health coverage (UHC), better levels of social protection and
regimen to treat people with MDR/RR-TB or pre-XDR-TB. A total of 92 countries were
multisectoral action on broader TB determinants are all essential to reduce the burden
using the 9-month oral regimens for the treatment of MDR/RR-TB, almost the same as in
of TB disease.
2021 and up from 65 in 2020.
About 50% of TB patients and their households face total costs (direct medical expenditures,
There was an increase in access to shorter (1–3 months) rifamycin-based regimens for TB
direct non-medical expenditures and indirect costs such as income losses) that are catastrophic
preventive treatment. In 2022, 0.60 million people in 74 countries were reported to have
(>20% of annual household income), far from the WHO End TB Strategy target of zero.
been treated with these shorter regimens, up from 185 350 people in 52 countries in 2021.
Globally in 2022, an estimated 2.2 million incident cases of TB were attributable to
undernourishment, 0.89 million to HIV infection, 0.73 million to alcohol use disorders,
0.70 million to smoking and 0.37 million to diabetes.
From 2019 to 2022, WHO worked with high TB burden countries to ensure the inclusion
of accountability mechanisms in national budget planning and pursuing assessment
during high-level missions and joint TB programme reviews with engagement of civil
society representatives, in line with WHO's multisectoral accountability framework on TB.
The Global TB Report features a TB-SDG monitoring framework that focuses attention
on 14 indicators that are associated with TB incidence. Monitoring of these indicators can
be used to identify key influences on the TB epidemic at national level and inform the
multisectoral actions required to end it.

TB FINANCE
By 2022, US$ 13 billion was needed annually for TB prevention, diagnosis, treatment and
care to achieve the global target agreed at the UN high-level meeting on TB in 2018.
There was a decline in global funding available on essential TB services from US$ 6.5
billion in 2019 to US$ 5.8 billion in 2022, which is less than half of the global target.
As in the previous 10 years, most of the spending on TB services in 2022 (80%) was from
The second UN high-level meeting on domestic sources.
TB was held on 22 September 2023. The In low- and middle-income countries, international donor funding remains crucial. The
resulting political declaration reaffirms main source is the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund).
existing commitments and targets and The United States Government is the largest contributor of funding to the Global Fund
includes new ones for the period 2023–2027. and is also the largest bilateral donor; overall, it contributes about 50% of international
donor funding for TB.
Read more Financing for TB research at US$ 1.0 billion in 2021 also continues to fall far short of the
global target of US$ 2 billion per year, constrained by the overall level of investment.

WHO’s GLOBAL TUBERCULOSIS PROGRAMME together with WHO regional and country offices: develops policies, strategies and
standards; supports the efforts of WHO Member States; measures progress towards TB targets and assesses national programme
performance, financing and impact; promotes research; and facilitates partnerships, advocacy and communication.

More information: www.who.int/tb