TB is not the kind of crisis that seizes media headlines; it is a quiet, slow-burning epidemic with a profound global impact, particularly in developing countries. It spreads through the air when people with lung TB cough, sneeze or spit, and disproportionately affects the poor. The disease thrives in overcrowded housing, in mining communities, in prisons, and among those with compromised immunity. Despite being preventable and curable, TB remains the world’s leading cause of death from a single infectious agent. In 2024 alone, the disease claimed an estimated 1.23 million lives and affected over 10.7 million people globally.
 

End TB Campaign

In South Africa, TB remains a major public health challenge, with drug-resistant TB (DR-TB) continuing to undermine progress. In 2024, an estimated 249 000 people developed TB, including 14 000 that had DR-TB, yet only about three in five people accessed treatment. TB-related deaths fell by a modest 17% between 2015 and 2024, reaching 54 000. The closely intertwined HIV and TB connection continues to shape the TB epidemic, with more than half of all TB patients living with HIV. TB remains the primary cause of death among this group.

These figures underscore why World TB Day matters. It’s a moment to reflect on progress and renew accountability. While progress is not victory, there is clear momentum. Supported by the concerted efforts of people affected by TB, community health workers, civil society, and private sector partners, the End TB Campaign, led by the National Department of Health (NDoH), has driven 2.9 million TB tests, reaching 58% of its ambitious target of five million, and diagnosing approximately 152 000 new TB cases ahead of March 2026. The Free State province alone achieved 55% of its target, identifying about 7 000 new TB cases. Although the target has not yet been reached, this effort is likely to result in the highest number of TB tests conducted in any single year.

 
Encouragingly, TB incidence in South Africa has declined substantially over the past decade, with reductions of more than half since 2015. Treatment coverage increased to 79%, and success rates improved across many districts. These gains reflect expanded screening, improved access to rapid diagnostics tools, stronger contact tracing, and wider provision of TB preventive treatment. However, persistent structural and systemic challenges continue to limit the full benefits of integrating TB and HIV services.

 
Eradicating TB is achievable
 

Launched in April 2025, the NDoH’s TB Recovery Plan 4.0 seeks to strengthen TB services disrupted during the COVID-19 pandemic while advancing progress toward the national End TB targets. The Plan emphasises generating demand for TB services through stronger communication and community engagement, recognising that people are more likely to act when they understand their risk, and trust the health system. It prioritises active case-finding among high-risk groups, including children, adolescents, and those living with HIV, while strengthening linkage to and retention in care, where gaps remain. However, this progress remains fragile; ongoing funding uncertainties and recent disruptions in health-related aid threaten to slow or even reverse these gains, underscoring the need to rethink current funding mechanisms to sustain and expand essential TB services. 

Ending TB is therefore no longer just a scientific challenge but also a test of leadership, long-term investment, and collective resolve. For universities, this moment calls for research that stretches beyond laboratories into communities. Addressing behavioural and social determinants of TB is essential if evidence is to meaningfully inform policy and practice.

While progress may feel incremental, South Africa’s End TB Campaign reflects a forward movement. TB control is increasingly embedded in community health systems and supported by national leadership. This growing momentum offers a reason for optimism; ending TB is not ambitious – it is achievable.

    Dr Ernest Peresu is a research fellow at the Centre for Health Systems Research & Development.

Institutional experts can be found at: https://www.ufs.ac.za/media/leading-researchers

Opinion article by Dr Ernest Peresu, Centre for Health Systems Research & Development (CHSR&D), University of the Free State