South-East Asia battles TB crisis as WHO warns 2030 elimination goals may slip away

The WHO South-East Asia Region, despite carrying nearly half of the global TB burden, is far off track from its 2025 End TB targets, with slow declines in incidence, drug-resistant strains rising, and millions still facing catastrophic costs. The report calls for urgent political will, domestic financing, innovation, and community-led action to prevent the region from missing the 2030 elimination goals.

The fight against tuberculosis in the WHO South-East Asia Region, as detailed in the World Health Organization’s 2025 report, draws on research from the WHO Regional Office for South-East Asia, Helixer Healthcare Private Limited, and the Regional Technical Advisory Group on TB. Their findings reveal a stark truth: this region, though home to a quarter of the global population, still carries nearly half the global TB burden. Progress has been sluggish. Since 2015, TB incidence has dropped by only 6.7 percent and deaths by 11 percent, far from the 2025 targets of 50 and 75 percent reductions. Even more troubling, 30 to 80 percent of TB-affected households suffer catastrophic costs, showing how the disease deepens poverty while destroying health.

Deep-Rooted Drivers of the Crisis

Why is progress so slow? The report highlights multiple drivers. Poverty, undernutrition, overcrowded housing, and limited access to quality care perpetuate transmission, while co-morbidities such as diabetes, HIV, smoking, and alcohol dependency heighten vulnerability. The vast private health sector, which often operates beyond the oversight of national programmes, delays diagnoses and fuels underreporting. Political commitment is uneven, and the COVID-19 pandemic severely disrupted TB services, pushing thousands into untreated illness. Together, these forces have entrenched the epidemic, making it clear that incremental steps will not be enough. Bold, systemic change is the only way forward.

Ambitious Declarations, Lingering Gaps

The 2023 United Nations High-Level Meeting on TB produced a sweeping political declaration. It pledged to diagnose and treat 45 million people, including 4.5 million children and 1.5 million with drug-resistant TB, by 2027. It called for preventive treatment for 30 million household contacts and 15 million people living with HIV, alongside US$ 22 billion annually in financing. It also emphasized rights-based care, stigma reduction, gender sensitivity and social protection. Yet the gap between rhetoric and reality remains. In 2023, about 22 percent of TB cases were still missed, with less than 40 percent of new or relapse patients receiving WHO-recommended molecular diagnostic tests. India’s Ni-kshay digital platform has expanded case notifications from private providers, and AI-powered chest X-rays are being piloted across the region. Still, detection and treatment lag behind the promises.

Drug-resistant TB looms as the toughest challenge. Nearly 170,000 cases were estimated in 2023, but only 44 percent were diagnosed and treated. India, Indonesia, and Myanmar together accounted for almost 90 percent of the region’s burden. New regimens such as BPaL and BPaLM have brought shorter, more tolerable all-oral treatments, with Nepal and Thailand showing encouraging cure rates above 80 percent. Yet weak laboratory systems and patchy access to drug susceptibility testing leave many patients undiagnosed or mismanaged. Children, too, remain overlooked. Of an estimated 650,000 child cases in 2023, only half were diagnosed and treated. Promising advances such as stool-based testing in India and Bangladesh and integration of TB screening into maternal health services in Myanmar are underway, but shortages of child-friendly drugs and paediatric expertise still hamper progress.

Prevention, Protection, and Innovation

Preventive treatment is a proven weapon, but one still underutilized. Household contacts and people with HIV, two of the most vulnerable groups, rarely receive consistent access. Bangladesh has integrated preventive therapy into primary care for children, India has rolled it out through HIV clinics with single-window services, and Thailand has expanded latent TB testing, yet overall coverage is poor. Social protection faces similar gaps. Though most countries offer free TB treatment, indirect costs devastate families. India’s Ni-kshay Poshan Yojana, which provides cash transfers for nutrition, has eased burdens, while donor-supported food baskets and travel vouchers have helped in some settings. But these remain fragmented, bureaucratically cumbersome, and underfunded.

Research and innovation bring cautious optimism. Portable AI-enabled chest X-rays, rapid sequencing for drug resistance, and non-sputum-based diagnostics are improving detection. Digital adherence tools, such as video-observed therapy, are reducing treatment dropouts. Most promising of all, vaccine development is accelerating, with candidates like M72/AS01E offering hope of preventing progression from latent to active disease. Social science research is also expanding, helping to uncover how gender, caste, and poverty shape access and outcomes. Still, the report warns that without consistent investment, many of these breakthroughs may remain pilots rather than transformative tools.

Financing the Final Mile

If there is one theme that runs through the report, it is the critical shortfall in funding. India and Thailand finance most of their programmes domestically, but others remain heavily dependent on international aid. In 2024, Bangladesh faced an 81 percent funding gap, Indonesia 56 percent, Myanmar 55 percent, and Nepal 54 percent. The sudden withdrawal of USAID support in 2025 has left programmes scrambling to cover essential costs. The WHO calls for urgent diversification of financing through tobacco and alcohol taxes, social impact bonds, diaspora contributions, and community health insurance. Without such innovation, vital services, from drug procurement to community support, risk collapse.

TB in South-East Asia is not just a health challenge but a developmental emergency. It strikes adults in their prime, reducing household incomes, deepening poverty, and sapping national productivity. Unless governments elevate TB elimination to a top priority, backed by robust financing and community-driven solutions, the 2030 global targets will remain beyond reach. Yet, with political resolve, new tools, and social protection systems that leave no one behind, the vision of a TB-free South-East Asia can still become a reality in the years ahead.