World TB Day…progress made, but why does tuberculosis still persist?

If one were to ask what is common to John Keats, Franz Kafka, D H Lawrence and George Orwell, those with even the slightest interest in English literature would know that they are all celebrated writers. However, there is another common thread binding them and that is the fact that they all died from tuberculosis.

In the 18th and 19th centuries, tuberculosis was so widespread in Europe that it came to be known as the “White Plague.” In some cities, it accounted for around one in seven deaths, making it one of the most feared diseases of the time.

Evidence of tuberculosis has also been found in Egyptian mummies dating back over 3,000 years, showing that the disease has accompanied human civilisation for millennia. Archaeological studies revealed spinal deformities such as vertebral collapse and curvature that are classic signs of TB infection. Modern science has since confirmed this through DNA analysis, detecting traces of the tuberculosis bacterium in ancient remains. Researchers have also identified lipid molecules from the bacterium’s cell wall, known as mycolic acids, which can survive for thousands of years thereby allowing scientists to detect tuberculosis even in ancient populations.

In fact in 19th-century European literature, tuberculosis was often romanticised as a disease of sensitivity and artistic genius, its slow and visible decline lending itself to tragic portrayals in novels and poetry.

That was until 24th March 1882, when German physician Robert Koch identified Mycobacterium tuberculosis, proving that the disease was infectious rather than hereditary or mysterious. This discovery is why the world observes World Tuberculosis Day each year on 24th March.

Yet, more than a century later, tuberculosis remains one of the world’s deadliest infectious diseases, claiming over a million lives each year. According to the World Health Organisation, around 10.6 million people fell ill with TB globally in 2022–23, with about 1.3 million deaths annually. Despite being preventable and curable, tuberculosis continues to remain one of the world’s leading infectious killers.

The century-old Bacillus Calmette–Guérin (BCG) vaccine continues to play an important role, particularly in protecting children from severe forms such as tuberculous meningitis and miliary TB. This is why it is administered at birth in many countries, including under India’s Universal Immunization Programme. However, its protection against pulmonary TB that is the most common and contagious form affecting adolescents and adults, remains limited.

This gap is significant because pulmonary TB spreads through airborne droplets released when an infected person coughs, sneezes or speaks, allowing the infection to pass easily from one person to another. While childhood vaccination prevents the most severe outcomes, limited protection in adults means transmission continues in communities.

India carries the largest share of the global TB burden, accounting for roughly 27–28% of cases. This makes India’s progress critical not only nationally but to global TB control. At the same time, it is important to note that India has made measurable progress in recent years, with incidence declining by around 20–21% between 2015 and 2024 that is higher than the global average decline of about 10–12%. Expanded screening, wider use of rapid diagnostics and strengthened treatment under the National Tuberculosis Elimination Programme have helped bring more patients into care.

Yet the scale of the challenge remains significant. Given that India is the world’s most populous country and carries the largest share of the global burden, even steady progress may not be sufficient. And thus the pace of decline must accelerate if elimination goals are to be achieved.

The persistence of tuberculosis, despite such progress also points to challenges that go beyond medicine. The disease spreads easily in crowded settings, and many cases are still detected late. Undernutrition and poverty increase vulnerability, while long treatment durations make adherence difficult. While all along drug-resistant forms of TB are making treatment more complex.

Completing treatment is therefore critical. Standard therapy for drug-sensitive TB lasts at least six months and can cure around 85–90% of patients if followed correctly. However, interruptions in treatment can lead to drug resistance, making the disease harder and longer to treat. Ensuring that patients complete the full course is therefore essential, not only for individual recovery but also for preventing the spread of more resistant forms of the disease.

As the world marks World Tuberculosis Day soon, the persistence of TB serves as a reminder that medical solutions alone are not enough. Greater awareness, stronger public health systems and sustained commitment will be essential to ensure that a preventable and curable disease no longer continues to claim lives.

END OF ARTICLE