The prevalence of tuberculosis (TB) has been steadily decreasing since the year 2000, but despite the colossal effort put into policy changes and government programs, TB has now surpassed HIV/AIDS as the leading cause of death from infectious diseases. One in three people worldwide are infected with TB, but far fewer actually get sick. The World Health Organization (WHO) has announced a plan to lower deaths from TB by 90%, which they set as a goal for 2030.

A global epidemic

In 2014, an estimated 1.5 million people died from TB and 1.2 million from HIV/AIDS, which includes 400,000 people who had HIV/AIDS and TB. TB is often opportunistic, preying on people with a weak immune system. Over 95% of infections occur in developing countries where healthcare is limited and government budgets stretched thin.

Promoting public awareness of TB is extremely important so that people can recognize symptoms and seek help as soon as possible. An obvious problem with fighting TB is the funding that goes into TB programs. Compared to global investments for HIV/AIDS, which was $21.7 billion in 2014, a paltry $6.6 billion was spent on TB prevention.

A serious problem that plagues developing countries is that physicians are reluctant to report all cases to local disease control centers and as a result statistics provided by government agencies are unreliable. The gap in the figures is quite disturbing. It is estimated that of the 9.6 million who got TB last year, a mere 62.5% of them (6 million people) were reported to government agencies, which means that 38% of the new cases weren’t diagnosed or recorded officially. If some countries are hiding the facts, organizations like the WHO are seriously underestimating the extent of disease prevalence.

The countries which had the highest incidence rates of TB in 2014 were Indonesia, Nigeria, Pakistan, People’s Republic of China and South Africa.

Addressing the problem of drug resistance

Studies have shown that in every country surveyed, TB strains that are resistant to standard treatment are present. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB that does not respond to first-line treatment, isoniazid and rifampicin. The main causes of MDR-TB are inadequate treatment, incorrect or inappropriate use of anti-TB drugs, or the use of low-quality medications. MDR-TB can be effectively treated with second-line drugs, but these may be limited in availability and are much more costly.

Extensively drug-resistant tuberculosis (XDR-TB) is a dangerous form of TB that fails to respond to even second-line treatment and requires serious drugs that often cause side-effects. Cure rates for MDR-TB are about 50%, and XDR-TB cure rates are even lower.

Effective decision-making

Examining the causes and adopting new strategies can help avoid the spread of drug resistant forms of TB. The United States recently released a National Action Plan to combat MDR-TB on a national and global level. Developing countries shouldn’t be hiding the true numbers, because underestimating TB prevalence can be detrimental, especially if it’s a drug resistant strain. TB is a curable disease and there is no reason why anyone should suffer.

FACT SHEET: Obama Administration Releases National Action Plan for Combating Multidrug-Resistant Tuberculosis. (2015, December 22). Retrieved December 28, 2015, from

Tuberculosis (Fact sheet N°104). (2015, October 13). Retrieved December 25, 2015, from


By Dr. Yuriy Sarkisov, BiMedis staff writer