The infectious disease that killed the most people last year is one about which we’ve heard almost nothing: tuberculosis.
In 2022, it likely claimed 1.4 million lives, more than the total toll of COVID. And yet, in rich countries — where virtually nobody dies of tuberculosis — attention has moved on. Even in poor countries, where the wealthier can afford treatment, it is often the poorest, most disconnected and disadvantaged who suffer from this disease.
The world has long promised to do better. As part of the United Nations’ global goals, known as the Sustainable Development Goals, all nations promised to fix almost every global problem by 2030, including tuberculosis. That’s not going to happen. Concerning tuberculosis, we will be decades late.
Indeed, we are failing on almost all the world’s 2030 promises. Based on current trends, the world will be half a century late delivering its promises. The reason is apparent: politicians made an impossible 169 promises, but having 169 priorities is indistinguishable from having none. Crucial targets on nutrition, education and tuberculosis are put alongside much more peripheral promises like boosting recycling, more urban parks, and promoting lifestyles in harmony with nature.
This year, the world will be at halftime for its 2030 promises, yet it will be nowhere near halfway. It is time to identify and prioritize the most crucial goals. My think tank, the Copenhagen Consensus, is doing precisely that: Together with several Nobel laureates and more than a hundred leading economists, we have been working for years to identify where each dollar can do the most good.
A new, peer-reviewed study shows that a dramatic reduction in tuberculosis is possible and one of the most effective priorities leading up to 2030.
Almost a quarter of all people in the world carry tuberculosis bacteria. Every 10th person has it even in rich Europe and the United States. For most well-off, well-nourished people, it will not develop into a disease, but it is a risk for the less fortunate. In that way, tuberculosis is a disease of hunger and poverty.
More than 10 million people develop tuberculosis annually. Because of a lack of resources, in 2021, we diagnosed only 6 million cases. Almost half the untreated people will go on to die. Those who don’t die will continue to spread the infection — on average, actively infected people can infect five to 15 others through close contact over a year.
Moreover, the 6 million diagnosed and offered treatment are in for a rough time. They must take medication for as long as six months. Because the medication clears the immediate tuberculosis symptoms like fevers and weight loss in a couple of weeks, many will drop out of treatment too early.
When people stop treatment too early, it increases the chance that the disease can be passed on to others and makes the surviving tuberculosis bacteria more likely to develop drug resistance. This means the subsequent treatment could require 18 to 24 months and will be much costlier.
We can do much better. It’s possible to diagnose many more people and ensure most TB patients stay on their medication. Our new study shows this can be achieved for an additional $6.2 billion annually. It is less than what the world promised — in 2018, the United Nations promised to increase funding by $7 billion to $8 billion annually by 2022. Disappointingly, spending since 2018 has declined.
The additional $6.2 billion annually can deliver diagnosis, care and prevention that will achieve the world’s tuberculosis promises. It would ensure that at least 95 percent of people with tuberculosis will receive a diagnosis. It can provide simple ways to ensure people complete their six months of medication — perhaps with incentives to complete the treatment, such as food, clothing, juice boxes or gift cards, or through support groups for patients to encourage one another. These days, apps on a cell phone can help.
The extra resources will mean that high-risk, vulnerable populations can access periodic screening. Over the coming decades, 50 million people will access appropriate treatment, and 35 million people will have access to preventive treatment.
This will dramatically reduce tuberculosis deaths by 90 percent. It will essentially wipe out the disease, as we should have done decades ago. Up to mid-century, the additional resources will allow us to avoid an astounding 27 million deaths and untold human suffering. The total benefits, expressed in economic terms, mostly from avoided deaths, would reach $3 trillion. Each dollar spent will generate $46 of social benefits for the world.
Global dithering has allowed tuberculosis to become the biggest infectious killer. Ending TB is one of the world’s most effective policies. We have promised way too much for 2030, but tackling tuberculosis is one of the few most effective policies we must carry through.
