By: Results Canada Published: 14/01/2024

Tuberculosis (TB) is the world’s leading infectious disease killer, claiming around 1.3 million lives in 2022 alone. TB is an airborne infectious disease caused by bacteria that primarily affects the lungs. As a disease that is strongly linked to the social and physical environments that surround people, TB disproportionately affects those living in poverty. The continued existence of TB shows just how persistent inequities are within global health. Even within Canada, TB is a concern among specific groups that are often marginalized, including Indigenous and newcomer communities.

Progress towards eradicating TB was severely disrupted by COVID-19 as national budgets, healthcare workers, and resources were redirected to address the pandemic. In fact, 2020 was the first year in over a decade in which TB deaths increased. While a significant global recovery in TB response was reported in 2022, we are still way off track to meet the global targets to eliminate this ancient disease.

Campaign summary: To fulfill the Global Plan to End TB by 2023 and to prepare for future threats, Canada must step up and increase investments into TB research and development (R&D) annually to develop and deliver new tools to prevent, diagnose, and treat this deadly infectious disease affecting millions at home and abroad.


Throughout the COVID-19 pandemic, we have seen the best of international collective action as well as its limits. Global scientific cooperation drove the rapid development of safe, highly effective COVID-19 vaccines. In just one year, 19 vaccines were approved. This surge in scientific innovation, backed by political will, led to a mass immunization effort that prevented millions of deaths. Yet we also witnessed blatant global vaccine inequity, as wealthy nations allowed their own interests to take priority over the need for global solidarity. Rather than bringing us closer, vaccines laid bare divides – most notably among socioeconomic fault lines.

The story of tuberculosis (TB) – the world’s deadliest infectious disease – also exemplifies deep-rooted inequity in global health. While COVID-19 highlighted inequities in access to existing vaccines, TB demonstrated inequity with which diseases we bother to develop vaccines for at all. The result is the existence of only one single vaccine for TB – an appalling testament to the neglect of diseases that predominantly affect those living in poverty.

This one vaccine – the Bacille Calmette-Guérin (BCG) vaccine – was introduced in 1921 and is one of the most widely administered vaccines in human history. But given its limited effectiveness, and the continued burden of TB in the world, the century-old vaccine reminds us of the lack of funding to address diseases that primarily affect marginalized communities.

Immunizations have been one of the greatest public health achievements in human history and no infectious disease has ever been eradicated in the absence of an effective vaccine. TB will be no exception. The development of a new TB vaccine could be a real game changer in the quest to end TB, as it is projected to be the single most effective intervention in bringing the world closer to TB elimination – one of the United Nations Sustainable Development Goal (SDG) 2030 targets.

more about tuberculosis

  • About one quarter of the world’s population is infected with TB bacteria and 5-10% of these individuals will go on to develop active TB disease.
  • In 2021, an estimated 10.6 million people fell ill with TB worldwide, including 3.4 million women and 1.2 million children.
  • TB is the leading cause of death among people living with HIV.
  • Drug-resistant TB (a type of TB disease that does not respond to medication) accounts for more than one third of all antimicrobial resistance-related deaths. Only about one in three people with drug resistant TB accessed treatment in 2021.
  • TB is heavily associated with the social determinants of heath – poverty, food insecurity, inadequate housing, and overcrowding are significant underlying risk factors for TB.
  • TB remains a public health concern in Canada as well, disproportionately affecting newcomer and Indigenous communities. For example, TB rates are almost 300 times higher among Inuit than for the Canadian-born non-Indigenous population.

Ending the TB epidemic will require developing and deploying new safe, effective, and affordable vaccines, and the next few years will be a decisive chapter in this story. Fortunately, #GameChangers in R&D are working hard: there are currently 17 candidates in the TB vaccine pipeline. After over 100 years with a single vaccine, such innovation is injecting a renewed sense of optimism into the TB movement.


The development of an antibiotic for TB in 1943 was a #GameChanger in TB treatment. The decades that followed brought the development of a few more antibiotics that, together, resulted in TB being considered a largely treatable disease. However, in the 1980s, four decades after this groundbreaking discovery, hopes that TB could be eliminated entirely were dashed with the rise of drug-resistant strains, which occur when disease-causing bacteria no longer respond to the drugs designed to treat them.

In response to increasing drug-resistance and the resulting resurgence of TB, the World Health Organization (WHO) declared TB a global health emergency in 1993. Drug-resistant TB continues to devastate the globe, and is defined by higher morbidity and mortality, and thus, higher cost and complexity.

Just as we saw the incidence of TB increase during the pandemic (with 10.6 million people sick with TB in 2021 alone), the burden of drug-resistant TB also increased by 3% between 2020 and 2021. The increasing threat of drug-resistance is an alarming reminder that appropriate treatment of infectious diseases to prevent resistant strains must be a global priority.

Drug-resistant TB develops when the long, complex, decades-old TB drug regimen is improperly administered, or when people with TB stop taking their medicines before the disease has been fully eradicated from their body. Once a drug-resistant strain has developed, it can be transmitted directly to others. Traditionally, drug-resistant TB was much more difficult to treat, requiring burdensome treatment regimens of up to 2 years, which only cured about half of those treated.

In 2019, there was another #GameChanger for TB treatments when TB Alliance – a nonprofit product development partnership dedicated to the discovery and development of new, faster-acting and affordable TB medicines – developed a new treatment regimen for drugresistant TB. The three-drug, all-oral, six-month regimen, known as BPaL, has shown a treatment success rate of about 89% in clinical trials and has been approved by the WHO. The shorter duration, lower pill burden and higher efficacy of this new treatment can help ease the burden on health systems, while improving treatment outcomes and quality of life for individuals with drug-resistant TB.


Of the estimated 10.6 million people who fall ill with tuberculosis (TB) every year, 4.2 million are missed by health systems. This means they do not receive a diagnosis or the care they need.

Billions of people, or about a quarter of the world’s population, are estimated to be infected with the bacterium that causes TB. Given that 5–10% will eventually develop TB disease, getting an accurate diagnosis can be a matter of life or death. Therefore, access to diagnostic tools is essential to addressing the TB epidemic. However, diagnosis remains the weakest link in the TB continuum of care. There is a large gap globally between the estimated number of people who fall ill with TB and the number of people diagnosed. between the estimated number of people who fall ill with TB and the number of people diagnosed.

High cost, low accuracy, inefficient sample collection, and limited accessibility of tests are preventing full access to diagnostic tools. This presents significant barriers to TB elimination, because we cannot end TB if we cannot find TB.

While early detection and appropriate treatment can cure TB, the high rate of TB infections highlights a lack of prompt diagnosis and treatment. Most TB diagnostic tools require a sample of sputum (mucus coughed up from the respiratory tract), but many cannot easily produce this, including people living with HIV, people with TB outside of the lungs, and children.

Luckily, #GameChangers in research and development (R&D) are working to improve the tools available to test for TB.

Ensuring that people with TB are not missed by health systems will require equitable access to non-sputum based diagnostic tests that are available where people are first accessing care. This means bringing tests closer to people, rather than requiring them to travel to centralized healthcare facilities. Ongoing development of new tools – like self-testing technologies along with tongue swabs and urine-based tests to simplify sample collection – will bring diagnostics to lower local levels of the health care system, helping to meet people and communities where they are.

next steps

While the science to develop new TB preventative, diagnostic and treatment tools is there, this progress, as well as the timely roll out of new technologies, is threatened by the severe funding shortfall for TB research and development (R&D). In 2018, at the first United Nations High-Level Meeting (UN HLM) on TB, member states committed to providing US$2 billion annually for TB R&D and for each donor country to contribute its “fair share”: 0.1% of its total R&D expenditure.

Every year since this commitment was made, the world has failed to meet the target even as the burden of TB increased for the first time in two decades. Canada, for example, hasn’t contributed its fair share even once – in 2021, it met only 67% of the target.

To make matters worse, the annual funding need for TB R&D has more than doubled due to years of severe underfinancing as well as the impacts of the COVID-19 pandemic on TB programming. The Stop TB Partnership’s Global Plan to End TB 2023-2030 calls on funders to contribute US$5 billion annually for TB R&D. In 2021, only US$1 billion was raised.

Percentage of fair share target Canada has met since 2018.

That’s why we are calling on Canada to reaffirm its commitment to ending TB but a political commitment isn't enough. Now more than ever, people affected by TB need solutions. Canada must back its word up with real action by meeting updated annual “fair share” investment targets in TB R&D and champion the development and delivery of new tools to prevent, diagnose, and treat TB. With the funding and political will to promote scientific development, game-changing innovations will bring us closer to a world where no one suffers from TB.

Campaign summary: To fulfill the Global Plan to End TB by 2023 and to prepare for future threats, Canada must step up and increase investments into TB research and development (R&D) annually to develop and deliver new tools to prevent, diagnose, and treat this deadly infectious disease affecting millions at home and abroad.


WHO Global Tuberculosis Report 2022
TB R&D Report 2022
Tuberculosis Factsheet
Global Plan to End TB 2023-2030
Canada TB Tracker

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