What Matters in Global Health - 168

WHO Warns TB Remains Top Infectious Killer Despite Progress in Fight to End the Disease

The Global Tuberculosis Report 2024 from the World Health Organization (WHO) warns of tuberculosis’s (TB) ongoing threat as a global health crisis, even as some progress is being made. This year, TB likely reclaimed its position as the world’s leading infectious disease killer, surpassing COVID-19. WHO Director-General Dr. Tedros Adhanom Ghebreyesus underscores that TB remains “the definitive disease of deprivation,” disproportionately impacting impoverished communities. “Turning the tide on TB,” Dr. Tedros asserts, means treating those infected while preventing new cases by addressing the underlying drivers, such as poverty and malnutrition.

The report reveals that 10.8 million people fell ill with TB in 2023, with over half of global cases concentrated in five countries: India, Indonesia, China, the Philippines, and Pakistan. Tragically, an estimated 1.25 million people died from TB this year. WHO Global TB Programme Director Dr. Tereza Kasaeva highlights a “multitude of formidable challenges,” including funding shortfalls, climate change, migration, and the spread of drug-resistant TB. She calls for “unwavering resolve” to tackle these obstacles and finally end TB.

Encouragingly, the global TB mortality rate continues to fall, reversing the concerning increases seen during the COVID-19 pandemic. Deaths dropped from 1.42 million in 2021 to 1.25 million in 2023, showing that post-COVID recovery efforts in TB diagnosis and treatment are beginning to pay off. In 2023, 8.2 million people were newly diagnosed, suggesting that healthcare services are addressing the backlog created by pandemic disruptions. WHO attributes this progress to improvements in healthcare systems’ capacity to identify and treat TB patients.

Moreover, the gap between the estimated number of new TB cases and those diagnosed is narrowing, and treatment success rates remain high for drug-susceptible TB while improving for drug-resistant cases. However, achieving WHO’s TB reduction targets remains a major challenge. Since 2015, the global TB incidence rate has fallen by just 8.3%, far from the 50% reduction target for 2025. Furthermore, financial burdens persist: around half of TB-affected households face “catastrophic costs” during diagnosis and treatment, underscoring the need for expanded social protection.

The report also looks ahead with cautious optimism. Six TB vaccine candidates are now in Phase III trials, hoping to roll out within five years. WHO envisions that a new vaccine could significantly reduce the burden of TB in high-incidence areas. Dr Kasaeva emphasises that “only through our collective determination can we make significant strides in our battle to end TB once and for all.” 

The 2024 Global Tuberculosis Report sends a clear message: while some progress has been made, a TB-free world will require sustained commitment, increased funding, and targeted policy action. Ending TB by 2030 is an ambitious goal, but WHO asserts it is achievable if countries unite to close gaps in care, support the development of new treatments, and protect those most vulnerable to this deadly disease.

Rising STI Rates Threaten Gauteng’s HIV Prevention Gains as Safe Sex Practices Decline

In Gauteng, South Africa’s wealthiest province, health officials are raising alarms over a troubling rise in sexually transmitted infections (STIs), even as HIV infections decline due to the widespread availability of protective drugs like PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis). "It’s a tale of two contrasts," explains Sithembile Nale, a sexual health counsellor. While the province celebrates reductions in HIV cases thanks to these preventative treatments and condoms, clinics are now seeing spikes in syphilis and gonorrhoea cases.

Abi Dlodlo, a sex worker in Johannesburg, notes a change in her clients’ attitudes toward safe sex. “They’re a new breed of clients,” she says, describing younger men who confidently offer more money for unprotected sex, believing PrEP and PEP shield them from risk. "They talk sweetly… betting on the thrill of unprotected sex." This confidence, driven by perceived protection from HIV, has led many to disregard the risks of other STIs, contributing to a surge in infections that is overwhelming healthcare facilities.

The issue appears exacerbated by Gauteng’s demographics. With a young, mobile population, including university students and young professionals, the province has become a hotspot for casual and transactional sex. “Gauteng’s manufacturing, townships, technical colleges and universities all give the province a youthful population,” says Nale. “That makes Gauteng a perfect hotspot for casual and transactional sex, especially in the key 17 to 30 population band.”

Public health experts suggest that PrEP, while effective against HIV, may inadvertently encourage unprotected sex among those who feel reassured by its benefits. “We believe that the high uptake of PrEP among women [in Gauteng] has led this group to have unprotected sex, resulting in a high incidence of MUS [Male Urethritis Syndrome],” notes Nomantu Nkomo Ralehoko, the province’s health minister. Rising STI rates, Nale warns, signal a growing public health crisis that must be addressed swiftly.

Dr Ndiviwe Mphothulo, president of the Southern African HIV Clinicians Society, underscores the urgency of addressing this trend, warning, "We should be worried about the rising numbers of STIs; it tells us that people are not using condoms. It’s a threat." The rise in STI infections could eventually undermine the gains made in HIV prevention, creating a renewed public health challenge for South Africa’s richest province.

Record Heat and Climate Change Drive Rising Health Threats, Lancet Countdown Warns

The 2024 Lancet Countdown report highlights the mounting health risks posed by climate change, revealing record-breaking threats as global temperatures soar. Since the 2015 Paris Agreement, hopes have been high to limit temperature rise to 1.5°C; however, the report warns that 2023 saw a global mean temperature of 1.45°C above pre-industrial levels, nearing that limit. Extreme weather events, including intense heatwaves and wildfires, have become regular, with heat-related mortality among people over 65 rising by a staggering 167% since the 1990s. Dr Marina Romanello, a co-author, calls this a “clear and urgent reminder” of the impacts of delayed climate action.

Heat exposure has profoundly affected daily life, with a record 27.7% increase in hours during which outdoor physical activity carries a risk of heat stress. Moreover, sleep quality has deteriorated due to rising night-time temperatures, contributing to a record 6% increase in hours of sleep lost. Alongside heat impacts, the report indicates growing vulnerability to extreme weather: 61% of the global land area experienced more days of heavy rainfall, heightening flood risks, while almost half faced severe drought for at least one month in 2023.

The report also outlines how shifting climates are intensifying infectious disease transmission risks. Malaria, dengue, and West Nile virus spread more easily as temperature and precipitation changes favour their vectors. The authors caution that these threats will only worsen without a robust response.

Climate change has also brought economic consequences, with heat exposure in 2023 alone leading to 512 billion potential labour hours lost, translating to $835 billion in lost income, disproportionately affecting low and middle-income countries. Despite some progress in renewable energy, global CO₂ emissions reached an all-time high, driven by fossil fuel production and deforestation. 

Another author, Dr Anthony Costello, argues that current responses are insufficient. “We need to build climate-resilient health systems and swiftly transition to renewable energy to protect future generations.” The report emphasises that investment in sustainable infrastructure, climate adaptation, and targeted support for vulnerable populations are crucial to limiting these escalating risks. Without decisive action, the Lancet Countdown warns, the health impacts of climate change will grow exponentially, further threatening human survival.