Are we within reach of ending TB?

Significant progress in tackling tuberculosis has created a renewed sense of possibility around ending TB, but achieving it will require collaboration, sustained investment, and a shared determination not to lose momentum, says Dr. Rachel O’Shea, Vice President, Global Access at Cepheid

The fight against tuberculosis (TB) is approaching an inflection point. TB remains one of the world’s deadliest infectious disease.¹ Millions still fall ill.¹ Too many die. And yet, there is something different about this moment.

For the first time in generations, ending TB is a credible possibility. Not inevitable. Not guaranteed. But within reach—if we choose to act.

This is a conclusion borne of evidence. Take the progress made over the past decades: data from the Global Burden of Disease Study² show that between 1990 and 2019, TB incidence in low-income and lower-middle-income countries fell from 285 to 176 cases per 100 000 people. Over the same period, deaths decreased from 63 to 46 per 100 000.²

Year after year, concerted action has driven down incidence and mortality. This momentum was interrupted only by the COVID-19 pandemic, when increases in undiagnosed and untreated TB led to rises in deaths and incidence in subsequent years.³

The COVID-19 crisis serves as a reminder of how fragile health systems can be, but it also shows something important; something that can fortify our efforts in TB: when surveillance weakens, TB resurges. When systems are strong, TB retreats.

The economics are compelling

The World Health Organization’s End TB Strategy has set ambitious targets: a 90% reduction in deaths and an 80% reduction in incidence by 2030.⁴ Yet funding has largely stagnated in recent years.¹ This is where the economic case for investment becomes impossible to ignore.

A recent cost–benefit analysis of the Global Plan to End TB (2023–2030), with outcomes modelled through 2050, found that every $1 invested in TB yields an estimated $46 in return.⁵ In human terms, the report shows that adequate TB investment would avert around 27,3 million deaths over the 28 years—around one million lives saved every year.

And, perhaps more importantly, the analysis compared scenarios with and without a new vaccine. Although the potential of a vaccine remains important, the model suggests much of the potential impact of the Global Plan can be realized by scaling existing interventions, including molecular diagnostics.⁵ Of course, modelling studies come with limitations. But the lesson is clear: the means to act are already in our hands.

Diagnosis drives outcomes

Over the past two years, there has been a shift from predominantly donor-led funding towards greater national ownership. Countries such as India and Indonesia are leading the way, increasingly investing domestic resources into their TB programmes.⁶

This is a critical step. Long-term progress will depend not only on innovation, but also on sustained political will and country-level determination.

And the evidence points to one intervention as particularly central to that effort: rapid diagnostic testing.

A recent nine-year analysis⁷ of WHO TB data across sub-Saharan Africa examined the impact of scaling up point of care molecular diagnostics. Over that period, TB incidence fell by 14%, mortality by 27,2%, and TB/HIV mortality by 64%.⁶

At the same time, molecular testing became the primary diagnostic approach—rising from just 7% of initial tests in 2015 to 66% in 2023.⁶

The use of precise and timely diagnostic tests such as Xpert® MTB/RIF Ultra was one of several independent predictors of TB mortality: regions with higher use of timely diagnostics consistently saw lower TB mortality, particularly among HIV-negative populations. Those with the lowest use of timely diagnostic tests, unfortunately, had highest mortality.⁷

This is not surprising. Molecular tests can help reduce the time to diagnosis from weeks to hours, improve sensitivity, and enable earlier, more appropriate treatment. They also help close one of the most persistent gaps in TB care: the large proportion of patients who are never diagnosed or are lost to follow-up before treatment begins.

And there’s more. Investment in diagnostic systems such as GeneXpert® systems also strengthens health systems—not only in managing other endemic diseases, but in building resilience to respond to emerging threats. Over the past decade, our innovation mindset has equipped countries with the tools to respond to emergency outbreaks such as COVID-19, Ebola and mpox.

A collective responsibility

Rapid molecular diagnostics are not a silver bullet. But they are a critical component of a broader effort to reach patients earlier and break chains of transmission, along with active case finding, treatment access, adherence support, and continued innovation.

At Cepheid, we see this work up close. We partner with global donors, NGOs, healthcare providers, and national TB programmes to bring diagnostic tools closer to the point of care, supporting earlier detection, faster treatment decisions, and stronger health systems.

Our commitment to high-burden countries is long-standing. Through our Global Access programme, we aim to ensure that these tools reach the communities that need them most.

But no single organization can do this alone.

Ending TB will require continued collaboration across governments, global health agencies, industry, and frontline providers. It will require sustained investment. And it will require a shared determination not to lose momentum at the point where progress is most within reach.

The opportunity to end TB in our generation is within striking distance. We cannot afford to miss it.