England has significantly reduced tuberculosis over the past fifteen years. But globally, millions of people with active TB are not being diagnosed or treated, and the disease continues to be one of the world's deadliest.

Tuberculosis (TB) is a serious infectious disease that attacks the lungs. It is the second-deadliest infectious disease worldwide after COVID-19, infecting more than ten million people each year, according to the UK Health Security Agency. The problem is that only 7.5 million of those 10.6 million cases are actually identified and treated. That means more than three million people have TB but are not receiving medical care, Reuters reported citing WHO data. This gap has barely changed since 2012, even though the world has had more than a decade to improve TB detection.

England's story is different. Between 2011 and 2017, TB cases in England fell by 38%, dropping from 8,280 to 5,102 new cases per year according to UKHSA. By 2021, the number had fallen further to 4,425 cases. The number of people dying from TB also declined: in 2002, about 7.1% of TB patients in England died, but by 2014 that had dropped to 5.5%.

These improvements came from focused public health work. Health officials traced people who had been in contact with TB patients, gave preventive treatment to people carrying dormant TB, and screened communities where TB was more common. However, even these efforts had gaps. In 2011, researchers discovered that TB screening at British airports and ports was missing most TB cases among people arriving from other countries. It took years of policy changes to improve this.

Deaths Are Part of the Picture Too

Behind every TB case is a human cost. In 2014, TB killed an estimated 1.5 million people worldwide. Of those deaths, about 400,000 occurred in people who were also living with HIV — and those deaths were officially counted as HIV deaths rather than TB deaths. This way of counting is medically accurate, but it has made TB less visible in global health statistics and affected how much funding and attention TB receives, BBC News noted at the time.

When someone has both HIV and TB, treating them becomes much harder. People with HIV are at much greater risk of developing active TB, and they need multiple medications that must be carefully coordinated. Many health systems in poorer countries struggle to provide this level of care consistently. The three million undiagnosed TB cases globally are concentrated exactly where HIV is common and where drug-resistant TB strains exist.

What This Means Going Forward

England's falling TB numbers are real, but they exist within a bigger global picture. A large share of TB cases in the UK come from people who were born in countries with high TB rates. This means that when millions of people globally remain undiagnosed and untreated, it affects TB in Britain too. The global TB problem does not stay far away — it reaches closer to home.

The World Health Organization has set a goal to reduce TB deaths by 90% and TB cases by 80% by 2030. Current progress suggests these targets will not be met. COVID-19 disrupted TB diagnosis and treatment systems between 2020 and 2022, slowing the progress that had been building. While some recovery has happened, health agencies say improvement has been slower than needed.

For people working to control TB, two separate challenges have emerged. England has shown that targeted screening and preventive treatment can work within a strong health system. But globally, three much larger problems remain: not enough diagnostic capacity to find TB cases, not enough funding for new TB medicines, and the way TB deaths in HIV patients are counted and reported. England's success is a proof of how it can be done. Making that happen worldwide is far harder.