Tuberculosis (TB), a preventable and curable disease, continues to pose a significant global health challenge. Despite advancements in treatment, TB remains the leading infectious disease killer worldwide. In 2023, TB claimed approximately 1.25 million lives. As a respiratory infection with increasing drug resistance, TB presents an ongoing threat to global health security, even within the United States.

Recent data indicates a concerning trend: TB cases in the U.S. have been rising. According to the Centers for Disease Control and Prevention (CDC), preliminary data suggests that 2024 saw the highest number of TB cases in the U.S. in more than a dozen years. This resurgence underscores the need for increased vigilance and robust public health initiatives.

The increase in U.S. TB cases mirrors a global pattern. In 2023, an estimated 10.8 million people worldwide fell ill with TB, marking an upward trend as 2020. In today’s interconnected world, TB is present in major cities across the globe. A person with active, untreated TB can transmit the disease to between 10 and 15 people annually.

“Despite being preventable and curable, tuberculosis (TB) remains a persistent health threat across the world,” as noted in recent global health reports.

The U.S. Context: Vulnerable Populations and Public Health Infrastructure

While the overall incidence of TB in the U.S. is relatively low compared to some other countries, certain populations are disproportionately affected. These include:

• People experiencing homelessness
• Immigrants and refugees from countries with high TB rates
• People with HIV
• Individuals in correctional facilities

For these vulnerable groups, factors such as limited access to healthcare, crowded living conditions, and compromised immune systems increase the risk of TB infection.

The resurgence of TB in the U.S. also highlights the importance of maintaining a strong public health infrastructure. Budget cuts to state and local health departments can weaken TB control programs, hindering efforts to identify, treat, and prevent the spread of the disease. This mirrors the concerns raised globally about reduced development assistance for health, wich “pose a serious threat to sustaining this momentum.”

Drug-Resistant TB: A Growing Concern

A particularly alarming aspect of the TB epidemic is the rise of drug-resistant strains. globally, an estimated 400,000 people developed drug-resistant TB in 2023. These strains are more tough and costly to treat, leading to higher mortality rates.

the development of drug-resistant TB is often linked to incomplete or inconsistent treatment.When patients do not adhere to their prescribed medication regimen, the TB bacteria can evolve and become resistant to the drugs.This underscores the importance of patient education,support,and directly observed therapy (DOT),where healthcare workers supervise patients taking their medication.

As stated, “Drug-resistant TB is one of the biggest causes of death from antimicrobial resistance.”

Economic and Social Impacts

Beyond the immediate health consequences, TB has significant economic and social impacts.The disease disproportionately affects individuals of working age, leading to lost productivity and income. The cost of TB treatment, especially for drug-resistant strains, can also be ample.

Furthermore, TB often carries a stigma, which can lead to discrimination and social isolation.This stigma can deter people from seeking diagnosis and treatment, further fueling the spread of the disease.

The economic cost to the U.S.is substantial. Consider the case of a hypothetical TB outbreak in a meatpacking plant in Nebraska. The lost productivity due to illness, the cost of testing and treating workers, and the potential disruption to the plant’s operations could easily run into millions of dollars. Similar scenarios could play out in other industries and communities across the country.

Hope for the Future: new Tools and strategies

despite the challenges, there are reasons for optimism. Scientific advancements have led to the development of new diagnostic tools, more effective treatments, and preventive therapies. For example, rapid molecular tests can now quickly detect TB and drug resistance, allowing for faster and more targeted treatment.

In addition, shorter, more tolerable treatment regimens for drug-sensitive TB have been developed, improving patient adherence and outcomes. Preventive therapy with drugs like isoniazid and rifapentine can also protect individuals at high risk of developing TB.

Countries,including the United States,have reaffirmed their commitment to global targets to end the disease at the United Nations High Level Meeting on the Fight Against Tuberculosis. Investments in TB programs are also strengthening health and community systems, making them more inclusive, more resilient and better prepared for other health threats. In 2024, more people were accurately diagnosed and successfully treated for TB than ever before.

What Can be Done? A Call to Action

To reverse the rising trend of TB cases in the U.S. and globally, a multi-pronged approach is needed:

• increased Funding: Federal, state, and local governments must invest in TB control programs.
• Improved Access to Healthcare: Ensuring that vulnerable populations have access to timely diagnosis and treatment is crucial.
• Enhanced Surveillance: Strengthening TB surveillance systems to detect outbreaks early.
• Public Awareness Campaigns: Educating the public about TB prevention, symptoms, and treatment.
• Research and Development: Investing in research to develop new and better tools to combat TB.

As emphasized, “This is not the moment to slow down the fight or turn our backs on TB. No, now is the moment to redouble our commitment to defeat the disease – to save millions of lives and to safeguard our collective future. We have the tools, and we know what works. What we need is political will and money.”

The fight against TB requires a sustained commitment from governments, healthcare providers, researchers, and communities. By working together, we can turn the tide against this ancient disease and protect the health of all Americans.