Global Trends: Tuberculosis
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Updated December 27, 2018
Global Trends: Tuberculosis
Tuberculosis (TB) remains a major, and evolving, health
Diagnosis and Treatment. TB is generally diagnosed
challenge in many parts of the world and a priority for the
using rapid molecular tests, sputum smear microscopy, and
U.S. Congress and international community. The U.S.
culture-based methods. Many countries rely on the second
government is one of the largest donors to global TB
to diagnose TB, because it is the cheapest method.
control efforts. The 116th Congress may consider future
However, that method detects only half of all TB cases and
funding needs for TB control, particularly for vaccine
cannot detect Rifampicin Resistant-TB (known as RR-TB
research and disease surveillance and detection through
which is resistance to the first line TB drug Rifampicin), or
strengthening health care infrastructure.
Multi Drug Resistant (MDR)-TB.
Tuberculosis
Drug-susceptible TB is treated by a six-month course of
Transmission and Prevalence. Infectious diseases cause
four antimicrobial drugs. The majority of cases are curable
over 25% of deaths globally, and TB is the leading cause of
when medicines are available and patients adhere to
death from a single infectious agent. TB is spread through
treatment. On average, 85% of drug-susceptible TB cases
the air, such as when a person inhales germs from an
were cured in 2017. If patients do not complete the
infected person’s cough or sneeze. An estimated 23% of the
treatment regiment, they can develop MDR-TB—when TB
global population is infected with TB bacteria, and about
does not respond to at least two anti-TB drugs. MDR-TB is
10% of individuals infected with the TB bacteria will
a top concern of many global health experts because MDR-
develop active TB. Latent TB becomes active and
TB carriers can transmit resistant forms of TB to others. Of
transmittable when a person’s immune system is
those who contracted MDR-TB in 2017, 55% survived.
suppressed, for example due to pregnancy, chemotherapy,
or HIV/AIDS. The latter represents a serious public health
Figure 2. Global TB Mortality Rate, 2000-2016
concern, as people with HIV are 20 to 30 times more likely
to develop active TB than those without HIV.
TB is considered a disease of poverty, and the global
disease burden is uneven. India, China, Indonesia, the
Philippines, Pakistan, Nigeria, Bangladesh, and South
Africa account for two-thirds of TB cases worldwide (see
Figure 1). In countries without comprehensive health care
infrastructure, TB control is especially difficult. The WHO
estimates that 3.6 million TB cases are undetected annually,
primarily because of inadequate monitoring and
surveillance capacity.
Figure 1. Burden of New TB Cases in 2017, by WHO
Region
Source: WHO Global TB Report, 2017.
Global Developments
The international community has made significant strides in
curbing TB deaths worldwide (see Figure 2); however, the
disease continues to spread, mostly unabated. The
international community has adopted several multiyear
plans to combat TB. In 2018, reflecting a deepening global
commitment to TB eradication, the WHO, the Stop TB
Partnership, and the Global Fund to Fight AIDS,
Tuberculosis, and Malaria (Global Fund) launched a joint
initiative to scale up access to TB prevention and care. The
“End TB Strategy” focuses on 30 high-burden countries to
Source: CRS graphic created using WHO data, 2018.
diagnose, treat and report an additional 40 million people
with TB. The aim is a 95% reduction in TB deaths by 2035
and a 90% reduction in the TB incidence rate compared
with 2015 levels. The strategy calls for bringing together
https://crsreports.congress.gov
Global Trends: Tuberculosis
critical interventions to ensure that all people with TB have
Global Funding
equitable access to high-quality diagnosis, treatment and
Global TB-related funding to 119 Low- and Middle-Income
prevention services, without facing catastrophic
Countries (LMICs) was $6.9 billion in 2018, compared to
expenditures or social repercussions.
$3.3 billion in 2006. 86% of the funding is from LMICs;
however, this figure is skewed by domestic financing
Key TB Facts (as of 2017)
provided by Brazil, Russia, India, China and South Africa
In 2017,
(BRICS). In low-income countries, international donor
10 mil ion people developed TB disease
contributions accounted for 57% of funding.
TB kil ed 1.3 mil ion people, about one person every 18 seconds
95% of TB cases and deaths occurred in developing countries
In 2015, the WHO estimated that $9.2 billion would be
Incidence (new cases per 100,000 people per year) fell by 2%
needed to control TB. At the 2018 United Nations (U.N.)
From 1990 to 2015, TB prevalence decreased by 41%
General Assembly High Level Meeting on TB, U.N.
From 2000 to 2017, some 54 mil ion deaths were averted through
Members agreed that TB control would cost an additional
improved diagnosis and treatment adherence
$3 billion, in part to address the rising costs of addressing
Among HIV-negative people, TB deaths fell by 29% since 2000
MDR-TB. Members also set goals of treating 40 million
affected people and improving access to affordable
treatments by 2022.
TB and HIV-positive individuals. In 2017, nearly 1
million persons living with HIV contracted TB. In 2017,
U.S. Government Response
TB was the leading cause of death for HIV-positive people,
The United States supports international efforts to address
killing 300,000. HIV/TB co-infection remains concentrated
TB through bilateral programs and multilateral institutions,
in Africa, which accounted for 84% of all deaths due to co-
including the Global Fund. Bilateral efforts are coordinated
infection. Overall, TB deaths among HIV-positive
by the U.S. Agency for International Development
individuals have decreased by 44% since 2000. In 2017,
(USAID) and co-implemented with the U.S. Centers for
84% of people living with an HIV/TB co-infection were
Disease Control and Prevention (CDC), National Institutes
receiving ART treatment, compared to 36% in 2005.
of Health, the Department of State, and the Department of
Defense.
2013-2017: Regional Improvements. The fastest regional
declines of new cases were in the WHO Europe region (5%
Authorization and Funding. In December 2018, Congress
per year), and the Africa region (4% per year). The TB
enacted the PEPFAR (President’s Emergency Plan for
mortality rate fell by 11% per year in the WHO European
AIDS Relief) Extension Act of 2018, authorizing support
region, and by 4% per year in the WHO South-East Asia
for programs that combat TB, HIV/AIDS and malaria.
region. During this period, the WHO reported notable
Through the FY2018 State and Foreign Operations
mortality rate declines in high TB burden countries
(SFOPS) appropriations (P.L. 115-141), Congress provided
including Russia (13%), Ethiopia (12%), Sierra Leone
$261 million for TB prevention and treatment programs, as
(10%), Kenya (8%), and Vietnam (8%).
well as $1.35 billion for a contribution to the Global Fund.
The Trump Administration proposed reducing bilateral TB
Research & Development (R&D). Development of a
funding to $178.4 million for FY 2019 (a 32% cut from
vaccine is crucial to meeting WHO TB reduction targets, as
FY2018), and proposed $925 million for a U.S. Global
an effective vaccine could protect adults from contracting
Fund contribution. Congress has not enacted FY 2019
TB. Twenty TB drugs and 12 TB vaccines were in clinical
SFOPS appropriations.
trials in 2018. Clinical trials conducted in Africa of the first
new TB vaccine in 100 years has shown promising results.
Strategy. In 2015, the Obama Administration released the
“U.S. Government Global Tuberculosis Strategy” to
Key Challenges
establish policy guidance and goals for 2015-2019. It aimed
to treat 13 million new positive TB cases, maintain
Multi-Drug Resistant-TB (MDR-TB)
treatment success rates for 90% of individuals with TB,
MDR-TB is spreading worldwide. In 2017 nearly 600,000
diagnose and begin treating 360,000 cases of MDR-TB, and
people developed RR-TB compared to 425,000 cases in
provide treatment for 100% of people diagnosed with
2005. Overall, 75% of MDR-TB cases go undetected by
HIV/TB co-infection. To date, the Trump Administration
health systems. Some experts indicate this reflects a need to
has not proposed a continuation of this strategy.
focus on strengthening health systems to improve
surveillance and detection of MDR-TB cases. The expense,
Sara M. Tharakan, Analyst in Global Health and
complexity, and side effects of treating MDR-TB
International Development
complicate treatment adherence. The development of
IF11057
improved treatments with shorter regiments and less severe
side effects, some argue, could help control the spread of
MDR-TB.
https://crsreports.congress.gov
Global Trends: Tuberculosis
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you
wish to copy or otherwise use copyrighted material.
https://crsreports.congress.gov | IF11057 · VERSION 3 · NEW
Updated December 27, 2018
Global Trends: Tuberculosis
Tuberculosis (TB) remains a major, and evolving, health
Diagnosis and Treatment. TB is generally diagnosed
challenge in many parts of the world and a priority for the
using rapid molecular tests, sputum smear microscopy, and
U.S. Congress and international community. The U.S.
culture-based methods. Many countries rely on the second
government is one of the largest donors to global TB
to diagnose TB, because it is the cheapest method.
control efforts. The 116th Congress may consider future
However, that method detects only half of all TB cases and
funding needs for TB control, particularly for vaccine
cannot detect Rifampicin Resistant-TB (known as RR-TB
research and disease surveillance and detection through
which is resistance to the first line TB drug Rifampicin), or
strengthening health care infrastructure.
Multi Drug Resistant (MDR)-TB.
Tuberculosis
Drug-susceptible TB is treated by a six-month course of
Transmission and Prevalence. Infectious diseases cause
four antimicrobial drugs. The majority of cases are curable
over 25% of deaths globally, and TB is the leading cause of
when medicines are available and patients adhere to
death from a single infectious agent. TB is spread through
treatment. On average, 85% of drug-susceptible TB cases
the air, such as when a person inhales germs from an
were cured in 2017. If patients do not complete the
infected person’s cough or sneeze. An estimated 23% of the
treatment regiment, they can develop MDR-TB—when TB
global population is infected with TB bacteria, and about
does not respond to at least two anti-TB drugs. MDR-TB is
10% of individuals infected with the TB bacteria will
a top concern of many global health experts because MDR-
develop active TB. Latent TB becomes active and
TB carriers can transmit resistant forms of TB to others. Of
transmittable when a person’s immune system is
those who contracted MDR-TB in 2017, 55% survived.
suppressed, for example due to pregnancy, chemotherapy,
or HIV/AIDS. The latter represents a serious public health
Figure 2. Global TB Mortality Rate, 2000-2016
concern, as people with HIV are 20 to 30 times more likely
to develop active TB than those without HIV.
TB is considered a disease of poverty, and the global
disease burden is uneven. India, China, Indonesia, the
Philippines, Pakistan, Nigeria, Bangladesh, and South
Africa account for two-thirds of TB cases worldwide (see
Figure 1). In countries without comprehensive health care
infrastructure, TB control is especially difficult. The WHO
estimates that 3.6 million TB cases are undetected annually,
primarily because of inadequate monitoring and
surveillance capacity.
Figure 1. Burden of New TB Cases in 2017, by WHO
Region
Source: WHO Global TB Report, 2017.
Global Developments
The international community has made significant strides in
curbing TB deaths worldwide (see Figure 2); however, the
disease continues to spread, mostly unabated. The
international community has adopted several multiyear
plans to combat TB. In 2018, reflecting a deepening global
commitment to TB eradication, the WHO, the Stop TB
Partnership, and the Global Fund to Fight AIDS,
Tuberculosis, and Malaria (Global Fund) launched a joint
initiative to scale up access to TB prevention and care. The
“End TB Strategy” focuses on 30 high-burden countries to
Source: CRS graphic created using WHO data, 2018.
diagnose, treat and report an additional 40 million people
with TB. The aim is a 95% reduction in TB deaths by 2035
and a 90% reduction in the TB incidence rate compared
with 2015 levels. The strategy calls for bringing together
https://crsreports.congress.gov
Global Trends: Tuberculosis
critical interventions to ensure that all people with TB have
Global Funding
equitable access to high-quality diagnosis, treatment and
Global TB-related funding to 119 Low- and Middle-Income
prevention services, without facing catastrophic
Countries (LMICs) was $6.9 billion in 2018, compared to
expenditures or social repercussions.
$3.3 billion in 2006. 86% of the funding is from LMICs;
however, this figure is skewed by domestic financing
Key TB Facts (as of 2017)
provided by Brazil, Russia, India, China and South Africa
In 2017,
(BRICS). In low-income countries, international donor
10 mil ion people developed TB disease
contributions accounted for 57% of funding.
TB kil ed 1.3 mil ion people, about one person every 18 seconds
95% of TB cases and deaths occurred in developing countries
In 2015, the WHO estimated that $9.2 billion would be
Incidence (new cases per 100,000 people per year) fell by 2%
needed to control TB. At the 2018 United Nations (U.N.)
From 1990 to 2015, TB prevalence decreased by 41%
General Assembly High Level Meeting on TB, U.N.
From 2000 to 2017, some 54 mil ion deaths were averted through
Members agreed that TB control would cost an additional
improved diagnosis and treatment adherence
$3 billion, in part to address the rising costs of addressing
Among HIV-negative people, TB deaths fell by 29% since 2000
MDR-TB. Members also set goals of treating 40 million
affected people and improving access to affordable
treatments by 2022.
TB and HIV-positive individuals. In 2017, nearly 1
million persons living with HIV contracted TB. In 2017,
U.S. Government Response
TB was the leading cause of death for HIV-positive people,
The United States supports international efforts to address
killing 300,000. HIV/TB co-infection remains concentrated
TB through bilateral programs and multilateral institutions,
in Africa, which accounted for 84% of all deaths due to co-
including the Global Fund. Bilateral efforts are coordinated
infection. Overall, TB deaths among HIV-positive
by the U.S. Agency for International Development
individuals have decreased by 44% since 2000. In 2017,
(USAID) and co-implemented with the U.S. Centers for
84% of people living with an HIV/TB co-infection were
Disease Control and Prevention (CDC), National Institutes
receiving ART treatment, compared to 36% in 2005.
of Health, the Department of State, and the Department of
Defense.
2013-2017: Regional Improvements. The fastest regional
declines of new cases were in the WHO Europe region (5%
Authorization and Funding. In December 2018, Congress
per year), and the Africa region (4% per year). The TB
enacted the PEPFAR (President’s Emergency Plan for
mortality rate fell by 11% per year in the WHO European
AIDS Relief) Extension Act of 2018, authorizing support
region, and by 4% per year in the WHO South-East Asia
for programs that combat TB, HIV/AIDS and malaria.
region. During this period, the WHO reported notable
Through the FY2018 State and Foreign Operations
mortality rate declines in high TB burden countries
(SFOPS) appropriations (P.L. 115-141), Congress provided
including Russia (13%), Ethiopia (12%), Sierra Leone
$261 million for TB prevention and treatment programs, as
(10%), Kenya (8%), and Vietnam (8%).
well as $1.35 billion for a contribution to the Global Fund.
The Trump Administration proposed reducing bilateral TB
Research & Development (R&D). Development of a
funding to $178.4 million for FY 2019 (a 32% cut from
vaccine is crucial to meeting WHO TB reduction targets, as
FY2018), and proposed $925 million for a U.S. Global
an effective vaccine could protect adults from contracting
Fund contribution. Congress has not enacted FY 2019
TB. Twenty TB drugs and 12 TB vaccines were in clinical
SFOPS appropriations.
trials in 2018. Clinical trials conducted in Africa of the first
new TB vaccine in 100 years has shown promising results.
Strategy. In 2015, the Obama Administration released the
“U.S. Government Global Tuberculosis Strategy” to
Key Challenges
establish policy guidance and goals for 2015-2019. It aimed
to treat 13 million new positive TB cases, maintain
Multi-Drug Resistant-TB (MDR-TB)
treatment success rates for 90% of individuals with TB,
MDR-TB is spreading worldwide. In 2017 nearly 600,000
diagnose and begin treating 360,000 cases of MDR-TB, and
people developed RR-TB compared to 425,000 cases in
provide treatment for 100% of people diagnosed with
2005. Overall, 75% of MDR-TB cases go undetected by
HIV/TB co-infection. To date, the Trump Administration
health systems. Some experts indicate this reflects a need to
has not proposed a continuation of this strategy.
focus on strengthening health systems to improve
surveillance and detection of MDR-TB cases. The expense,
Sara M. Tharakan, Analyst in Global Health and
complexity, and side effects of treating MDR-TB
International Development
complicate treatment adherence. The development of
IF11057
improved treatments with shorter regiments and less severe
side effects, some argue, could help control the spread of
MDR-TB.
https://crsreports.congress.gov
Global Trends: Tuberculosis
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you
wish to copy or otherwise use copyrighted material.
https://crsreports.congress.gov | IF11057 · VERSION 3 · NEW