Imagine a silent killer lurking in the air, stealing lives at an alarming rate. In South Africa alone, Tuberculosis (TB) claimed the lives of approximately 54,000 people in 2024. That's more than 148 people every single day! According to the latest World Health Organization (WHO) estimates, a staggering 249,000 South Africans contracted this disease in the same year. But here's the controversial part: these numbers, while shocking, might actually be underestimations.
Let's break down what this means for you, your family, and your community.
TB, caused by bacteria that spreads through the air, primarily attacks the lungs. Anyone can contract TB simply by breathing in infected air droplets, making it a truly indiscriminate threat. A cough, a sneeze, even just talking can spread the disease.
The good news? The overall trend shows a slow but steady decline in TB deaths in recent years. Consider this: two decades ago, at the height of the HIV epidemic, TB was responsible for around 200,000 deaths annually in South Africa. The connection between HIV and TB is undeniable. Uncontrolled HIV infection significantly increases the likelihood of developing active TB disease. Think of it as HIV weakening the immune system, making individuals more vulnerable to TB's aggressive attack.
The success of South Africa's HIV treatment program has directly contributed to the reduction in TB cases and deaths. Of those 54,000 TB-related deaths in 2024, approximately 29,000 occurred in people living with HIV, while 25,000 were in individuals who tested negative for HIV. This highlights the importance of comprehensive healthcare and integrated treatment strategies.
The number of new TB infections is also decreasing. The WHO estimates that 249,000 people fell ill with TB in 2024, a drop from 270,000 in 2023 and 292,000 in 2022. Just two decades ago, this number often soared above 600,000.
And this is the part most people miss: While these improvements are encouraging, a significant challenge remains. Many people with TB are simply not getting diagnosed and treated. In 2024, only about 184,000 people were diagnosed with TB in South Africa, representing just 74% of those who actually had the disease. This means an estimated 65,000 people with TB went undiagnosed and untreated, potentially spreading the infection further.
To address this gap, the South African government has set an ambitious goal: to conduct five million TB tests between April 2025 and March 2026. However, according to data obtained by Spotlight and GroundUp, only around 1.75 million tests were conducted in the first six months (April to September 2025). This raises serious questions about whether the government will achieve its target. Even if the target isn't met, it's still projected that more TB tests will be conducted this year than in any of the past ten years.
It's important to note that the WHO's estimates come with relatively wide confidence intervals, reflecting the inherent uncertainty in disease modeling. For instance, the actual number of people falling ill with TB in 2024 could range from 155,000 to 365,000. This highlights the complexity of tracking and predicting disease patterns.
However, the WHO's estimates generally align with those from Thembisa, a leading mathematical model of TB in South Africa. The most recent Thembisa estimates, published in 2024, suggest around 62,000 TB deaths in adults from mid-2023 to mid-2024, a figure slightly higher than the WHO's estimate (and excluding children). Updated estimates from Thembisa are anticipated soon.
Here's another layer of complexity: Both the WHO and Thembisa estimates significantly differ from Statistics South Africa's (StatsSA) report, which recorded approximately 20,000 TB deaths in 2022 (the latest year with available StatsSA figures). Why the discrepancy? StatsSA relies on death certificates, and there's compelling evidence that HIV and TB are dramatically underreported on these documents. This underreporting can stem from stigma, incomplete medical records, or simply a lack of awareness. In contrast, the WHO and Thembisa use sophisticated modeling techniques, drawing on multiple data sources to create more comprehensive estimates.
Globally, TB remains a major public health threat. In 2024, an estimated 1.23 million people died from TB worldwide, making it the leading cause of death from a single infectious agent. Approximately 10.7 million people contracted TB, but only 8.3 million were diagnosed.
The global TB epidemic is heavily concentrated in certain regions. India accounts for 25% of all TB cases, followed by Indonesia (10%), the Philippines (6.8%), China (6.5%), and Pakistan (6.3%). While these countries have larger absolute numbers of TB cases than South Africa, South Africa's TB case rate per 100,000 people (389) is higher than all of these countries except for the Philippines. South Africa ranks 12th highest globally in terms of TB cases per capita.
Unsurprisingly, South Africa remains on the WHO's list of countries with high TB burdens and high burdens of drug-resistant TB. In 2024, there were an estimated 14,000 cases of drug-resistant TB in the country. Drug-resistant TB is a particularly dangerous form of the disease, as it is much harder to treat and requires longer, more complex, and often more toxic treatment regimens.
The WHO's new report primarily focuses on 2024 data, meaning it largely predates the recent and significant cuts to health-related aid and research from the United States in 2025. But even before these cuts, the WHO was already sounding the alarm about inadequate TB funding. "Funding for the TB response remains grossly inadequate and has been stagnating," the report states.
In 2024, funding for TB prevention, diagnosis, and treatment totaled US$5.9 billion, while funding for TB research reached US$1.2 billion in 2023. These figures represent only 27% and 24%, respectively, of the global targets of US$22 billion and US$5 billion annually by 2027.
Dr. Tereza Kasaeva, Director of the WHO's Department for HIV, TB, Hepatitis and STIs, warned that these funding cuts pose a serious threat. She stated that modeling studies predict that long-term cuts to international donor funding could result in up to 2 million additional deaths and 10 million new TB cases between 2025 and 2035. Even short-term funding disruptions could lead to hundreds of thousands of excess deaths. Dr. Kasaeva emphasized the urgent need for countries to increase domestic resource allocation alongside international funding.
The fight against TB is far from over. While progress has been made, significant challenges remain, particularly in diagnosis, treatment adherence, and funding. Are the current strategies effective enough? What more can be done to reach the undiagnosed and ensure access to quality care? And crucially, how will the recent funding cuts impact the fight against TB in South Africa and globally? Share your thoughts and concerns in the comments below.
