Last year, the global battle to reduce tuberculosis infections and deaths showed small signs of recovery following three disruptive COVID-19 years – but this year’s precipitous drop in development aid is likely to cause new setbacks, according to the World Health Organization (WHO).

TB killed 1.23 million people in 2024 and made 10.7 million people sick in 2024, according to the Global TB Report 2025 released by the WHO on Wednesday (12 November).

There was a tiny 3% decline in deaths and a 1% decline in new infections last year in comparison to the previous year.

But the impact of the precipitous drop in development aid, particularly from the United States since January, is not reflected in the report, which tracks data from 2024, noting only that: “Cuts to international donor funding from 2025 onwards threaten overall funding for the TB response in many countries.” 

Speaking at a WHO press conference Wednesday, Director General Dr Tedros Adhanom Ghebreyesus described as “good news” the decline in new TB cases and deaths. “Meanwhile, the number of people being tested and treated is increasing and research is advancing for the first time in over a century. New effective TB vaccine for adolescents and adults are within reach,” Tedros said, noting that 18 vaccine candidates are currently in clinical development, including six in Phase 3 trials.

“Despite all this good news… TB still killed more than 1.2 million people in 2024 which for a disease that’s preventable and curable is simply unconscionable,” Tedros said, adding that, “funding cuts to international aid in many low and middle income countries threaten to reverse the hard won gains we see.

“It’s therefore vital that countries step up domestic resource allocation, alongside international funding.”

Just eight countries account for 67% of TB cases: India (25%), Indonesia (10%), the Philippines (6.8%), China (6.5%), Pakistan (6.3%), Nigeria (4.8%), the Democratic Republic of the Congo (3.9%) and Bangladesh (3.6%).

‘Concerning trends’

The WHO has already seen “some concerning trends” for  2025, particularly in the highest burden, low- and middle-income countries (LMICs) that have been “heavily dependent on international donor funding”, said Dr Tereza Kasaeva, WHO director for HIV, TB, Hepatitis and STIs.

These include disruptions to access to TB treatment, diagnosis and prevention; problems with monitoring and reporting, drug delivery, sample transportation, and “one of the biggest impacts”, community engagement, she told a media briefing before the launch.

The report notes that estimates of the impact of the funding cuts, particularly by the US, include “about half a million additional deaths and 1.4 million additional cases in the period 2025–2035 if USAID funding is not replaced, increasing to about two million additional deaths and five million additional cases when cuts in contributions to the Global Fund are also considered”.

Least progress made in funds mobilisation

Even before the funding cuts, progress in achieving TB goals fell far short of global targets. The worst-performing targets for 2024 relate to funds mobilisation.

Only $5.9 billion of 2027’s $22 billion target for TB treatment had been collected, and slightly more than 20% of the $5.5 billion research target for 2027 has been achieved.

Despite the lack of resaerch funds, the WHO notes that development pipeline is strong.

“As of August 2025, 63 diagnostic tests were in development and 29 drugs were in clinical trials – up from just eight in 2015. Additionally, 18 vaccine candidates are undergoing clinical trials, including six in Phase 3.”

Drop in deaths

Since 2015, there has been a 29% drop in deaths – but the target was a 75% reduction by this year. 

However, two WHO regions have done substantially better than the global average: Europe, which cut deaths by 49% by 2024; and Africa, with a 46% reduction in deaths, mainly as a result of better outcomes for people coinfected with HIV.

Similarly, there has only been a 12% drop in TB incidence against a global target of 50% between 2015 and 2025. However, Europe achieved a 39% decrease and Africa, a 28% decrease.

In contrast, TB incidence has risen by 5% or more in Indonesia, Myanmar and the Philippines. 

Meanwhile, 47% of households with people living with TB face “catastrophic” health costs against a target of zero.

However, Kasaeva noted that 8.3 million people who were newly diagnosed with TB in 2024 accessed treatment, “representing about 78% of the people who fell ill with the disease during that year”.

In addition, the coverage of rapid testing for TB diagnosis increased from 48% in 2023 to 54%, while there was an 88% success rate for “treatment for drug-susceptible TB”.

Building sustainable systems

However, Dr Yogan Pillay, Gates Foundation’s director for HIV and TB delivery, said that several countries were “stepping up, both in increasing domestic financing and looking at other ways of delivering services” since the cuts in aid.

He singled out Indonesia, Nigeria and South Africa for upping domestic financing for TB in the wake of cuts to global health financing.

“That’s what we need to focus on now. How do we develop systems that are sustainable, including in low and middle-income countries?” Pillay asked.

“We need to change the ways in which we do things so that we can sustain the gains that we’ve seen in the 2024 data, notwithstanding any funding cuts.”

A significant proportion of the TB burden is driven by five major risk factors: undernutrition, HIV infection, alcohol abuse, smoking and diabetes, according to the report.

“Tackling these issues, along with critical determinants like poverty and GDP per capita, requires coordinated multisectoral action,” according to the WHO.

The report concludes by noting that, in the face of cuts to international donor funding from 2025, “political commitment and domestic funding in high TB burden countries are more important than ever”.

Image Credits: Arnaldo Salomão Banze, ADPP Mozambique.