Widespread undetected tuberculosis is leaving one in five patients across the European region without crucial care, as health services fail to identify a vast number of infections.

This critical diagnostic gap was highlighted in a joint surveillance report published by the World Health Organization (WHO) European Region and the European Centre for Disease Prevention and Control (ECDC) ahead of this year’s World Tuberculosis Day on 24 March.

“It is a missed chance to treat earlier, prevent suffering and stop further transmission,” said Dr Hans Kluge, WHO Regional Director for Europe.

According to the WHO data, this diagnostic crisis is exacting a particularly heavy toll on vulnerable groups, including children. To combat these massive shortfalls and curb transmission, the WHO is rolling out novel, low-cost diagnostic tools.

Eastern European nations drive regional epidemic

The WHO European region recorded 161,569 newly diagnosed cases in 2024, representing only 79% of the estimated actual infections. The disease predominantly strikes vulnerable groups, disproportionately affecting seasonal migrants, people living with HIV, and prisoners.

Driving the WHO European Region’s epidemic are Russia, Ukraine, Uzbekistan, Türkiye, and Romania, which all faced estimated burdens of over 10,000 new tuberculosis infections in 2024. Persistent structural limitations in healthcare systems and a lack of integrated, patient-centred care are the primary drivers behind the region’s diagnostic struggles.

When cases remain hidden from health systems, the delay routinely leads to severe illness and ongoing transmission within communities. TB is highly contagious and is transmitted from person to person when an individual with a pulmonary infection expels bacteria into the air by coughing or spitting.

Furthermore, incomplete treatments and undetected tuberculosis act as catalysts for drug-resistant bacterial mutations, which are compounded by the displacement of populations in crises like the ongoing war in Ukraine.

With 23% of new cases showing resistance to standard medications, the European region’s rate exceeds the global average sevenfold.

Protecting children from undetected TB

Children bear a particularly heavy burden due to these massive diagnostic gaps, underscoring the continued need for vigilant paediatric surveillance. While the broader WHO European Region encompasses 54 nations across Europe and Central Asia, localized datasets tracking the 30 countries of the European Union and Economic Area (EU/EEA) show that children under 15 accounted for 4.2% of all new and relapse cases in 2024.

Citing WHO estimates, the medical charity Médecins Sans Frontières (MSF) warned that 43% of the 1.2 million children who contracted the disease globally in 2024 were never diagnosed.

“The tools to diagnose and treat children with tuberculosis may not be perfect, but they exist. Despite this, only half of the sick children receive a diagnosis or treatment,” explained Dr Cathy Hewison, head of the MSF international tuberculosis working group, in a press statement.

To combat the undetected tuberculosis crisis in younger demographics, MSF is advocating for the wider implementation of a 2022 clinical algorithm that enables doctors to diagnose children based on clinical symptoms when laboratory tests are unavailable.

Initial studies across five African nations showed this method doubled the number of children successfully diagnosed and treated.

Decentralising care in high-burden regions

In 2024, an estimated 10.7 million people fell ill with the disease worldwide, resulting in 1.23 million deaths. The overwhelming majority of these new infections remain concentrated in South-East Asia, sub-Saharan Africa, and the Western Pacific.

The latter region alone recorded an estimated 2.9 million cases, and it is home to three of the world’s top five high-burden countries: Indonesia, the Philippines, and China. Furthermore, these same nations are driving the global drug-resistance crisis, as China and the Philippines alone account for over 14% of the world’s multidrug-resistant infections.

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“Ending TB in the Western Pacific Region is achievable – if we transform care, decentralise services, and act with ever greater urgency,” emphasised Dr Saia Ma’u Piukala, the WHO Regional Director in a press statement.

To combat these high numbers, health leaders are actively pushing for decentralised care to bring diagnostic tools directly to marginalised communities. Integrated primary care and the rapid rollout of new tests are seen as essential steps to reduce transmission and reach vulnerable populations.

Transformative tools to eliminate tuberculosis

To address the global undetected tuberculosis crisis, WHO has now recommended near point-of-care nucleic acid amplification tests (NPOC-NAATs) alongside the use of tongue swabs for patients who cannot produce sputum. These portable, battery-operated devices deliver results in under an hour at a fraction of current costs, representing a major technological breakthrough for peripheral health clinics.

As global health programs face critical funding shortages in 2026, these newly recommended tests offer a vital economic lifeline, delivering rapid results at a fraction of current costs. ”

These new tools could be truly transformative for tuberculosis, by bringing fast, accurate diagnosis closer to people, saving lives, curbing transmission and reducing costs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a press statement marking World Tuberculosis Day 2026.

Despite the grim reality of diagnostic gaps, long-term surveillance data offers genuine reasons for optimism, as general incidence rates across the European region have fallen by 39% since 2015. Furthermore, worldwide tuberculosis deaths have declined by 29% since 2015, while the global treatment success rate for non-resistant infections remains robust at 88%.

By scaling up rapid, oral treatment regimens and investing in the newly recommended point-of-care molecular tests, health experts emphasise that countries still have a vital window to eliminate the epidemic entirely. Doing so is critical to meeting the UN Sustainable Development Goals and the WHO End TB Strategy, which aim for an 80% reduction in TB incidence and a 90% reduction in deaths by 2030.

Image Credits: European Union, Felix Sassmannshausen/HPW, World Health Organization.