Dr Bilawal Kamran
As the world marks World Tuberculosis (TB) Day, we are reminded of the tragic reality that, despite being preventable and curable, TB continues to claim more than a million lives every year. TB, a contagious bacterial infection primarily affecting the lungs, but which can also spread to the brain, kidneys, and bones, remains one of the most pressing global health issues. According to the World Health Organization (WHO), in 2023, 10.8 million people fell ill with TB, and 1.25 million lives were lost to the disease. The emergence of multidrug-resistant TB (MDR-TB), which is resistant to the two most potent TB drugs, further compounds the global health security threat. Alarmingly, only two in five patients with MDR-TB are receiving appropriate treatment, indicating the urgent need for a more robust response to this growing crisis.
The burden of TB disproportionately impacts low- and middle-income countries, driven by risk factors like undernutrition, smoking, diabetes, and HIV. While there has been some progress—over 79 million lives have been saved through global TB efforts since 2000—this progress is at risk. A critical reduction in funding for TB initiatives has disrupted essential services, including diagnostics, human resource deployment, data systems, and medicine supply chains. In 2023, only 26% of the $22 billion needed for global TB care was available. Moreover, research into TB remains severely underfunded, with only a fifth of the $5 billion research target met in 2022.
Pakistan’s TB situation is especially concerning. According to the World TB Report 2024, Pakistan accounted for 6.3% of the global TB burden in 2023, making it one of the countries with the highest number of cases. The country also contributed nearly 8% to the global gap between estimated TB incidence and the actual number of diagnosed and reported cases. This discrepancy highlights significant challenges in TB case detection, diagnosis, and reporting. These shortcomings underscore the urgent need for enhanced efforts in TB surveillance, diagnosis, and treatment across the country.
Pakistan is also among the 10 countries with the largest gaps in access to MDR-TB treatment. This situation suggests major deficiencies in the diagnosis, reporting, and treatment rollout for resistant TB strains, which threatens to undermine any efforts to curb the spread of the disease. Decades of underinvestment in public health have left Pakistan’s TB control program heavily reliant on donor support, which is both unsustainable and inadequate in the face of a growing crisis.
For Pakistan to tackle its TB crisis effectively, it must prioritize increasing domestic investment in TB diagnosis, treatment, and research. The country can no longer depend solely on external financial assistance to address the ongoing TB epidemic. Pakistan needs to allocate more resources towards expanding access to WHO-recommended rapid diagnostics, which are critical for timely TB detection, especially in remote areas where the disease is often underreported. With rapid diagnostic tools, healthcare providers can identify TB cases more effectively, ensuring early treatment and reducing transmission rates.
Furthermore, improving Pakistan’s reporting and surveillance systems is essential for better tracking and monitoring of TB cases. The existing gaps in data collection and analysis hinder the country’s ability to respond quickly to emerging TB threats, including the spread of MDR-TB. Strengthening these systems will help ensure that TB patients receive the right treatment promptly and that the government can monitor progress toward achieving national and international TB elimination goals.
Another critical area in need of attention is the treatment of MDR-TB. Pakistan must scale up access to shorter all-oral MDR-TB regimens, such as BPaLM, which have shown promising results in improving treatment outcomes for patients with drug-resistant TB. These shorter treatment regimens not only improve patient adherence but also reduce the long-term costs of treating MDR-TB, making it a more viable option for resource-constrained countries like Pakistan.
Addressing TB effectively in Pakistan also requires a more integrated approach to healthcare. TB care must be integrated into broader primary and lung health services, as the disease often overlaps with other risk factors such as diabetes, undernutrition, and air pollution. Diabetes, for example, is a significant comorbidity for TB, as it weakens the immune system and makes individuals more susceptible to developing active TB. Similarly, undernutrition and pollution contribute to the spread and severity of TB, making a comprehensive approach to lung health essential.
The WHO has called on governments worldwide to “Commit. Invest. Deliver” in the fight against TB. For Pakistan, this call to action is especially urgent. The government must prioritize TB as a major health issue and allocate sufficient resources to strengthen the country’s response to the epidemic. This includes not only increasing financial investment but also committing to long-term policy reforms that ensure TB control efforts are sustainable and effective.
Pakistan’s TB crisis is far from over, and without a coordinated and comprehensive response, the situation is likely to worsen. The country must urgently invest in scaling up TB diagnosis and treatment, improving surveillance and reporting systems, and ensuring that MDR-TB treatment reaches those who need it most. At the same time, integrating TB care with broader public health initiatives will help address the root causes of the disease, including undernutrition, diabetes, and pollution.
Moreover, Pakistan’s public health infrastructure needs to be strengthened to ensure that it can effectively respond to the growing burden of TB. This includes improving the quality and capacity of healthcare facilities, training healthcare workers, and ensuring that medicines and diagnostic tools are available where they are needed most.
While donor support remains important, Pakistan cannot rely on external funding alone. The country must make TB elimination a national priority by increasing domestic investment in TB control programs. The resources required are significant, but the cost of inaction is far greater. By investing in TB control, Pakistan can reduce the health and economic burden of the disease, save lives, and move closer to achieving the goal of TB elimination.
As we observe World TB Day, it is essential that Pakistan’s leaders take the WHO’s call to action seriously. They must commit to a sustained and robust response to the TB epidemic, invest in necessary resources, and deliver on their promises to eliminate TB as a public health threat. The fight against TB is not just about saving lives; it is also about ensuring a healthier, more prosperous future for Pakistan’s people. The time to act is now.
