Tuberculosis (TB) continues to be a global health burden. According to the World Health Organization, an estimated 10.8 million people contracted TB worldwide in 2023, and the disease is present in all countries and age groups.¹ A total of 1.25 million people died from TB in 2023, which likely makes it the world's leading cause of death from a single infectious agent, according to the WHO.¹
Additionally, with high incidence rates comes the issue of resistance. Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat.¹ Half a million people fall ill with MDR-TB and rifampicin-resistant TB each year, and the disease is responsible for nearly one-third of all AMR-related deaths globally.2,3 Only about 2 in 5 people with drug-resistant TB accessed treatment in 2023.¹
Interestingly, MDR-TB is most prevalent in five countries: India, Russia, Indonesia, China, and the Philippines.
“We need to assist those countries in their diagnosis and treatment of their patients, because they are, in a sense, a threat to TB elimination around the world,” said William Schaffner, MD, professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.
Although MDR-TB seems to be concentrated largely in those countries and is a bigger public health burden internationally, it can step present problems in the US.
“It can be exported to the rest of the world just through travel,” Schaffner said. “People could get on a plane and come here or go anywhere, and consequently spread their MDR TB.”
Still, he also pointed out the contrast in the reality of the MDR-TB problem in developed countries compared to those with limited resources.
“In the United States, MDR-TB accounts for less than 1% of all the TB cases reported. This is true also in other developed countries. The market in those countries that are most able to pay is, of course, the least. The market in developing countries is international, where the market is much less certain,” Schaffner stated.
What You Need to Know
Tuberculosis continues to impact millions globally, with 10.8 million cases and 1.25 million deaths in 2023, making it likely the leading infectious disease killer.
MDR-TB poses a serious global threat due to limited access to treatment—only 40% of those with drug-resistant TB received care in 2023.
Although the TB drug development pipeline is the most promising it’s ever been, progress is slowed by funding issues and political disruptions. More clinical trials, lab infrastructure, and global collaboration are essential to bring effective treatments to market, especially for resistant forms of TB.
Current Pipeline
According to the World Health Organization (WHO), 28 drugs for the treatment of TB are currently in phase 1, phase 2, or phase 3 trials. These drugs include 18 new chemical entities.4
However, potential disruptions—such as the pandemic and, more recently, the Trump administration’s pause in research funding—can significantly delay development by diverting resources and funding elsewhere.
“Whilst the current TB drug pipeline is the most robust it has ever been, further trials and an evidence base are required to select the most effective regimens. This will require further political commitments, funding, and development of additional clinical trial and laboratory infrastructure,” Tiberi et al write.5
Treatment Adherence
Beyond drug development, Schaffner emphasizes the importance of treatment adherence.
“Sixteen percent of these MDR-TB cases, at least, are in people who've previously received therapy where the therapy likely was too abbreviated, too short, or they took the drugs erratically,” said Schaffner. “From time to time in the United States, we’ve employed directly observed therapy. That is where a public health worker actually goes to the patient's house every day, stands there with a little cup of water and the medicine, and watches the patient take the drug if the patient was deemed perhaps not reliable enough to take the drug by themselves. Directly observed therapy has been shown to be very effective.”
References
1.Tuberculosis. WHO. Updated March 14, 2025. Accessed April 8, 2025.
https://www.who.int/news-room/fact-sheets/detail/tuberculosis
2. Tackling the Drug-Resistant TB Crisis. WHO. . Accessed April 8, 2025.
https://www.who.int/activities/tackling-the-drug-resistant-tb-crisis
3. Antimicrobial Resistance. TB Alliance. Accessed April 8, 2025.
https://www.tballiance.org/why-new-tb-drugs-antimicrobial-resistance/
4. Research and development for tuberculosis. WHO. Accessed April 8, 2025.
https://www.who.int/observatories/global-observatory-on-health-research-and-development/analyses-and-syntheses/tuberculosis/analysis-of-tb-r-d-pipeline
5. Tiberi S, Vjecha MJ, Zumla A, Galvin J, Migliori GB, Zumla A. Accelerating development of new shorter TB treatment regimens in anticipation of a resurgence of multi-drug resistant TB due to the COVID-19 pandemic. Int J Infect Dis. 2021;113 Suppl 1:S96-S99. doi:10.1016/j.ijid.2021.02.067
