In 2023, Tuberculosis Reclaimed Its Position as the World's Leading Cause of Death From a Single Infectious Agent, Surpassing COVID-19. With 10.8 Million New Cases and 1.25 Million Deaths in One Year Alone, TB Is Not a Disease of the Past.

Tuberculosis has a peculiar place in the public imagination. It is associated with 19th century literature and pre-antibiotic medicine, with sanatoriums and a time before effective treatment existed. For most people in high-income countries, it does not register as a present-day threat. That perception is dangerously wrong. TB kills more people per year than HIV and malaria combined. It has been doing so for most of recorded history. The COVID-19 pandemic disrupted the slow but real progress that global TB control programs had been making since 2015, and the consequences of that disruption are now visible in the data. This peer-reviewed commentary published in the International Journal of Infectious Diseases synthesizes and critically interprets the WHO Global Tuberculosis Report 2024, the most comprehensive annual assessment of the global TB epidemic and of progress toward the End TB Strategy targets. What it finds is a disease that has recovered its deadly preeminence while the world's attention was elsewhere.

Goletti et al. conducted a critical interpretation and synthesis of the WHO Global Tuberculosis Report 2024, which itself drew on data gathered from national ministries of health across 194 countries in annual rounds of data collection. The authors examined global and regional trends in TB incidence and mortality, the status of drug-resistant TB, the intersection of TB and HIV, progress toward the End TB Strategy milestones and targets, and the structural and systemic factors contributing to the current trajectory. The commentary contextualizes the 2024 report findings against the End TB Strategy milestones set for 2025 and targets set for 2030, and evaluates the adequacy of current diagnostic, preventive, and therapeutic infrastructure to meet those goals.

In 2023, an estimated 10.8 million individuals fell ill with tuberculosis globally. The number of newly diagnosed and reported TB cases reached 8.2 million, the highest ever recorded since WHO began monitoring in 1995. An estimated 1.25 million people died from TB in 2023, nearly doubling the fatalities attributed to HIV and AIDS in the same year. After three years during which COVID-19 held the position of leading infectious disease killer, tuberculosis reclaimed that position in 2023.

Progress toward the End TB Strategy targets has fallen critically short. Since 2015, TB incidence has decreased by only 8.3%, against a 2025 milestone of 50% reduction. TB mortality has decreased by approximately 29% since 2015, against a 2025 milestone of 75% reduction. Both milestones are now out of reach. Drug-resistant TB (DR-TB) compounds the challenge further. An estimated 400,000 people developed multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) in 2023, yet only 44% received treatment. The global gap between estimated incident TB cases and diagnosed and reported cases narrowed to 2.7 million in 2023, down from approximately 4 million during the pandemic years of 2020 and 2021, but remains a substantial surveillance and care gap.

The eight countries accounting for two thirds of global TB cases in 2023 were India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), Pakistan (6.3%), and three others. The burden is heavily concentrated in South and Southeast Asia, though the disease affects every region.

• —The underlying data for the WHO Global TB Report 2024 is derived from national ministry of health reporting, which varies substantially in quality, completeness, and timeliness across the 194 countries covered. Estimates for countries with weak surveillance infrastructure carry wide uncertainty intervals.
• —The commentary format means this paper does not present new primary data. It synthesizes and interprets WHO-reported figures, which are themselves modeled estimates rather than complete census counts of TB cases and deaths.
• —TB mortality and incidence figures are likely undercounts in settings with high rates of undiagnosed disease, weak vital registration systems, and limited autopsy capacity. The 1.25 million death figure is an estimate with uncertainty bounds.
• —The progress metrics toward End TB Strategy targets reflect a baseline of 2015 and may be affected by how baseline estimates have been revised across report editions.

Tuberculosis kills more people than any other single infectious agent on earth. It is curable. The tools to diagnose, treat, and in some settings prevent it exist. The funding, infrastructure, and political attention required to deploy those tools at the scale the burden demands have not materialized. The COVID-19 pandemic accelerated a setback that was already visible before 2020. The 2030 End TB targets are not on track. The 1.25 million people who died from TB in 2023 are not a historical footnote. They are a clear reflection of what global health prioritization looks like when a disease stops making headlines.