Shaka Brown was diagnosed with tuberculosis (TB) in November 2023.

“I was dropped off at the emergency room in Miami, Florida,” he recalled. “In September, I thought I’d caught the flu, but after weeks of night sweats, fainting spells, and losing my hearing in my left ear—and over 50 pounds—I knew something was wrong.”

Brown underwent ultrasounds, X-rays, and a battery of tests within hours of arriving. Then, the doctors delivered the news: he had TB.

“I told them no one gets TB,” he said. But Brown was quickly moved to a negative-pressure isolation room. “It turned out they were right. I had TB everywhere.”

The bacteria had spread from Brown’s lungs to nearly every organ in his body, including his bladder, brain, and spine. The infection had compromised his lower spine, causing sharp pain down his leg.

“The hospital had a molecular diagnostic machine, which helped them quickly figure out that I needed a specialised drug regimen. The standard treatment wouldn’t work for me,” he said.

“I started life-saving antibiotics the next day—over 15 pills every day. The TB growth was halted within a week. I remember slowly opening my eyes, surrounded by doctors who told me I was going to make it. It was only then I realised how close I’d come to not making it.”

Despite daily pills, four months later, Brown was back in the hospital, this time with seizures and unable to speak.

“The TB in my brain wasn’t going away as quickly as they hoped,” Brown said.

A week later, he underwent brain surgery to remove the infection. His doctors added anti-seizure medication to his TB regimen.

“They told me they’d stick with me every step of the way,” he added.

However, as Brown highlighted Tuesday during a presentation of new TB data by the World Health Organization (WHO), not everyone shares his good fortune.

“Twenty percent of people who get TB are never diagnosed and, therefore, never treated,” he said. “If we could just identify and treat those individuals, we could save lives. Every person we miss gives the bacteria a chance to evolve, weakening the effectiveness of current treatments. Yet, funding for research to develop effective drugs is decreasing.”

TB is top infectious disease killer in 2023

Brown’s message was underscored by the WHO’s release of its 2024 Global Tuberculosis Report. The 68-page report offers comprehensive data on TB trends and the global response, covering 215 countries and regions, including all 193 WHO member states. It provides the latest insights into the TB epidemic, tracking global, regional, and national progress, along with the impact of key factors driving the disease.

In 2023, TB reclaimed its position as the world’s leading infectious disease killer, following three years when COVID-19 took the lead. It caused almost twice as many deaths as HIV/AIDS. Specifically, there were an estimated 1.25 million deaths in 2023, including 161,000 amongst people with HIV.

“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “WHO urges all countries to make good on the concrete commitments they have made to expand the use of those tools, and to end TB.”

Globally, the number of deaths caused by TB fell in 2023, reinforcing the decline seen in 2022 after increases during the worst years of the COVID-19 pandemic. However, the number of people contracting TB rose slightly to approximately 8.2 million, the highest number recorded since WHO began global TB monitoring in 1995. This represents a notable increase from the 7.5 million reported in 2022.

Of those who developed TB, 55% were men, 33% were women, and 12% were children and young adolescents.

While TB occurs worldwide, 87% of cases in 2023 came from 30 high-burden countries. The majority of new TB cases were in Southeast Asia (45%) and Africa (24%), with smaller percentages in the Western Pacific (17%), Eastern Mediterranean (8.6%), the Americas (3.2%), and Europe (2.1%).

Eight countries accounted for two-thirds of the total: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of Congo.

Several major risk factors drive a significant portion of TB cases, including undernutrition, HIV infection, alcohol use disorders, smoking (especially amongst men), and diabetes.

Since 2000, TB prevention and treatment efforts have saved 79 million lives. The global gap between estimated TB cases (incidents) and reported new diagnoses (notifications) narrowed to about 2.7 million in 2023, down from around 4 million in 2020 and 2021 and below the pre-pandemic level of 3.2 million in 2019.

Drug-resistant TB remains a serious public health threat, said Dr. Tereza Kasaeva, WHO’s Global TB Program director. Presenting the data to health officials and the press on Tuesday alongside Brown, she noted that in 2023, 175,923 people were diagnosed and treated for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB)—just 44% of the estimated 400,000 cases worldwide.

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Kasaeva said progress toward global TB milestones and targets is lagging, including those set for 2027. Global funding for TB prevention and care dropped in 2023. Of the $22 billion target, only $5.7 billion was received—just 26% of the goal, with low- and middle-income countries bearing 98% of the TB burden.

“With only 26% funding, it’s impossible to provide 100% access for everyone in need,” Kasaeva said.

Domestic sources provided 80% of TB funding, while international funding for low- and middle-income countries has held steady at around $1.2 billion per year. Funding for TB research also remains critically low at around $1 billion per year—just a fifth of what’s needed.

“This is absolutely insufficient,” Kasaeva said.

“We are confronted with a multitude of formidable challenges: funding shortfalls and catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics, and drug-resistant tuberculosis, a significant driver of antimicrobial resistance,” Kasaeva added. “It is imperative that we unite across all sectors and stakeholders, to confront these pressing issues and ramp up our efforts.”

‘We can end TB’

The United States is the largest bilateral donor to global TB efforts, thanks to bipartisan support from Congress, explained Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID), who also spoke on Monday.

Since 2000, USAID has invested $4.7 billion in the fight against TB.

“We have a global TB strategy for 2023 to 2030 that focusses on our 24 priority countries,” Vincent said.

The strategy aims to ensure that 90% of people with TB, including drug-resistant TB, are diagnosed and treated. It also seeks to provide preventive treatment for 30 million people eligible for it.

“While it’s heartening to see some positive trends in our battle against TB, we must confront a harsh reality: despite our efforts, we are merely treading water, failing to make significant strides toward our goal of ending TB,” said Dr Cassandra Kelly-Cirino, executive director of the International Union Against Tuberculosis and Lung Disease, in response to the report.

“To create a world free from TB, we must urgently address the areas where we continue to fall short.”

She added, “We’re diagnosing only 48% of the individuals needed to meet the 90% target. This is unacceptable. We must ramp up testing, ensure timely diagnosis, and support effective treatment to turn these numbers around and accelerate the reduction in the global TB incidence rate.”

Similarly, Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, stated, “The big message from this year’s World TB Report is that if we act decisively, we can end TB.”

“We have momentum, tools, and leadership, but we need more funding—and we also need to dismantle human rights and gender-related barriers that prevent people from accessing the services they need,” he continued. “Winning will take political will and sustained commitment. In a world facing increasing challenges from conflict and climate change, we cannot hesitate.”

Image Credits: Stop TB Partnership, Shaka Brown's official website, World Health Organization.