When most of us in the UK think about infectious disease threats, tuberculosis (TB) rarely makes the list. It feels like a Victorian illness — something from history books, sanatoriums, and old black-and-white photographs. The reality is very different. TB is still very much with us, and it remains the world’s leading infectious killer.
The scale of the problem
In 2024, an estimated 10.7 million people fell ill with TB worldwide, including 5.8 million men, 3.7 million women and 1.2 million children. Around 1.2 million people died from the disease that year, keeping TB firmly in place as the world’s top infectious disease killer — ahead of HIV/AIDS and malaria combined.
Perhaps the most striking figure is this: about a quarter of the global population is estimated to have been infected with TB bacteria at some point. Most of these people will never become unwell, because the bacteria can lie dormant in the body for years — sometimes decades — before ever causing active disease, if it does at all.
The burden is not spread evenly. Over 80% of cases and deaths occur in low- and middle-income countries, with the largest share of new cases found in the WHO South-East Asia Region, followed by the Western Pacific and African regions. Poverty, overcrowding, malnutrition and limited access to healthcare all play a significant role in where TB thrives.
Why “preventable and curable” still isn’t enough
TB is often described as preventable and curable — and it genuinely is. Yet the gap between what medicine can do and what actually happens on the ground remains enormous. Around 8.3 million people were newly diagnosed in 2024, up slightly from 8.2 million the previous year, which sounds like progress until you consider that millions of cases still go undiagnosed or unreported each year, allowing the disease to keep spreading quietly within communities.
Drug-resistant TB adds another layer of difficulty. Multidrug-resistant TB (MDR-TB) remains a serious public health threat, and only around two in five people with drug-resistant TB currently access proper treatment. Standard TB treatment already requires a demanding course of antibiotics taken daily for four to six months; drug-resistant strains can mean treatment stretching to two years, with lower chances of a cure.
Funding is arguably the biggest constraint of all. Global investment in TB prevention, diagnosis and treatment reached $5.9 billion in 2024 — only a fraction of the $22 billion annual target set for 2027. Cuts to international donor support have only widened that gap further.
A rare piece of good news
It isn’t all bleak. The latest WHO data shows the rate of new TB infections fell by around 2% between 2023 and 2024, and deaths fell by roughly 3% — the first decline recorded since the disruption caused by the COVID-19 pandemic. Some regions have made striking progress: the WHO African Region saw incidence fall by 28% and deaths fall by 46% between 2015 and 2024, while Europe recorded even larger reductions over the same period.
There is also encouraging progress in research. New TB vaccine candidates are working their way through clinical trials, and improved short-course treatments for drug-resistant TB have recently been approved. None of this is guaranteed to translate into eliminating the disease, but it does show that sustained investment and public health effort genuinely moves the needle.
Why this matters for preparedness
I’m not a doctor, and this isn’t medical advice — for anything TB-related, from symptoms to treatment to vaccination decisions, your GP or a qualified healthcare professional is the right port of call. I’ll also say plainly that I’m not writing this to push people towards or away from any particular vaccine; that’s a personal and medical decision, not something for a preparedness blog to weigh in on.
What I do think is worth reflecting on is what TB tells us about resilience and preparedness more broadly. It’s a reminder that “old” diseases don’t necessarily go away — they persist wherever the conditions that allow them to spread (poverty, overcrowding, strained health systems, funding shortfalls) continue to exist. It’s also a reminder that global health threats rarely stay neatly contained within borders; TB is present in every country, including the UK, and outbreaks in one part of the world have a way of becoming relevant everywhere else eventually.
Basic preparedness principles apply here as much as with any other infectious disease: understanding the symptoms (a persistent cough lasting more than three weeks, unexplained weight loss, night sweats, and fatigue are the classic warning signs), knowing when to seek medical attention, and understanding that early diagnosis dramatically improves outcomes and reduces the risk of onward spread.
TB has been described as a disease the world already knows how to beat. The tools — diagnostics, treatment, and increasingly effective prevention — largely exist. What’s missing is the sustained political will, funding, and healthcare infrastructure to deploy them everywhere they’re needed. Until that changes, TB will remain a stark example of how a “preventable” disease can still quietly claim over a million lives a year. Get The Book – Preparing for Lockdown