World TB Day observed annually on March 24, amplifies the urgency of ending tuberculosis—the world’s deadliest infectious disease. TB continues to devastate millions globally, inflicting severe health, social, and economic consequences. This year’s theme, Yes! We Can End TB: Commit, Invest, Deliver, is a bold call for hope, urgency, and accountability.
– World Health Organization
Written by Jennifer Collins, PhD student in Nursing & Infection, prevention and control with the Safeguarding Health Through Infection Prevention research group at Glasgow Caledonian University. Jennifer has a background in Infection Prevention and Control (IPC), public health and nursing, with an interest in antimicrobial resistance prevention, planetary health and environmental sustainability.
With this World TB Day theme: “Yes! We Can End TB: Commit, Invest, Deliver” I discuss the rising rates across Scotland1 (with a 40% rise in 2023), Britain2 and other high-income countries3,4 . I ask if can we commit to invest, deliver, and truly eradicate TB, and if part of the solution lies in historic approaches to this disease.
For many in Britain when they hear tuberculosis (TB) mentioned they often think it’s a historical disease. When working as a TB specialist nurse in the NHS, I often heard reactions like, “That still exists?” or “We still have that in the UK?”. A lot of that reaction is justified; we’ve come a long way in Britain from mass TB treatment and prevention campaigns in the UK5, successfully reducing the general threat of TB, though it remained persistent in high-risk groups. However, this success may be at threat with current rates rising across Scotland and England. With this public health concern growing it may be that the key to stopping our current increasing trends lies in these historical managements of tuberculosis.
TB, one of the oldest recorded diseases, has been identified in ancient Egyptian mummies over 4,000 years old6. Typical symptoms include a persistent cough lasting over three weeks, fatigue, fever, night sweats, loss of appetite, weight loss and new swellings that don’t go away in a few weeks1. However, symptoms can be vague and Contrary to common belief, TB can affect various parts of the body and may present without respiratory symptoms. TB does not always cause immediate sickness8. Many adults carry latent TB, which can activate when the immune system is compromised.
In Britain, TB became a major public health issue following the industrial revolution which led to overcrowding and unsanitary conditions5, the perfect breeding ground for Tuberculosis. Despite public health systems being formed in the early 1900’s by 1948 tuberculosis was killing someone every 48 hours in Scotland7. With advancements in treatments to combat drug-resistance (thanks in part to Sir John Crofton of the University of Edinburgh) along with mass screening and vaccination, TB cases saw a steady decline globally until the 1990’s5. The HIV epidemic increased TB cases due to heightened susceptibility among HIV-positive individuals, posing new public health challenges9. Although successful treatments and programme have been implemented globally, TB now faces an additional new challenge in the development of multi-drug resistant strains of TB10.
Since 2020, the UK has observed rising TB cases, possibly due to COVID-19-related system pressures11. The UK Health Security Agency reports increase in TB cases above 10% in England from 2022-2023, with a 40% rise reported in Scotland within the same period1. Previous trends showed increases in non-UK born populations, however 2023 reported increases in both UK-born and non-UK born populations across England, particularly in high-risk group2. With medical treatments and vaccinations making up just part of the prevention strategy (unfortunately BCG vaccination is not fully protective) it is important that public health efforts include early diagnosis, case finding and managing environments through good ventilation, respiratory etiquette and natural light8,12. Additionally, a healthy immune system is imperative to reduce activation of TB and clear TB infection in the first place9.
With this in mind there is a need to consider wider systematic impacts that increase TB risk such as housing (with crowded living circumstances and lack of ventilation contributing to spread), access to nutrition (to ensure healthy immune responses) and strong awareness raising to reduce the burden of infections from positive cases8,9. Over 30% of cases in Scotland in 2023 were within the most deprived areas1. Broader thinking to targeted public health campaigns is needed for TB, considering the full socio-economic spectrum of issues involved in TB prevention12. When we think back to the historic TB campaigns which encouraged people to engage in respiratory hygiene, ventilation, public screening campaigns and access to treatment5, perhaps engaging old public health successes and social improvements while combining them with new technologies, treatments and screening methods, is key to ending TB one and for all.
In the current cost of living crisis there is a need for broader thinking out with solely healthcare approaches. Engagement and investment in housing and other social systems is needed in addition to public health and medical efforts9,11. Achieving this requires alignment with the World TB Day theme across Scotland, the UK and more globally through commitment, investment, and effective service delivery for TB. By implementing comprehensive and effective strategies, including modern takes those that have been historically successful, perhaps we can finally put TB in the past.
Sources:
- Public Health Scotland. Update on TB in Scotland. 2024 Mar. Available from: https://publichealthscotland.scot/news/2024/march/update-on-tb-in-scotland/
- UK Health Security Agency. Tuberculosis in England: 2023 report (data up to end of 2022). 2024 Feb 15. Available from: https://www.gov.uk/government/statistics/tuberculosis-in-england-2023-report
- Robert Koch Institute. 2025. Report on the Epidemiology of Tuberculosis in Germany – 2023 Executive Summary. Available at: https://www.rki.de/EN/Topics/Infectious-diseases/Diseases/TB/summary_2023.html#:~:text=In%202023%2C%204%2C481%20tuberculosis%20cases,was%20an%20increase%20of%2010.4%25.
- Centers for Disease Control and Prevention (CDC). Provisional 2024 Tuberculosis Data, United States. Available from: https://www.cdc.gov/tb-data/2024-provisional/index.html#:~:text=TB%20cases%20and%20rates&text=In%202024%2C%2010%2C347%20TB%20cases,in%20rates)%20(Figure).
- Migliori GB, Kurhasani X, van den Boom M, Visca D, D’Ambrosio L, Centis R, Tiberi S. History of prevention, diagnosis, treatment and rehabilitation of pulmonary sequelae of tuberculosis. La Presse Médicale. 2022 Sep 1;51(3):104112.
- Zink A, Maixner F, Jäger HY, Szikossy I, Pálfi G, Pap I. Tuberculosis in mummies–New findings, perspectives and limitations. Tuberculosis. 2023 Dec 1;143:102371.
- 60 years for the NHS in Scotland. 2008. Tuberculosis. Available at: https://60yearsofnhsscotland.co.uk/history/public-health-challenges/health-improvement/tuberculosis/
- Prevention of TB. [2024]. Available from: https://www.tbalert.org/about-tb/what-is-tb/prevention/
- Migliori, G.B., Dowdy, D., Denholm, J.T., D’Ambrosio, L. and Centis, R., 2023. The path to tuberculosis elimination: a renewed vision. European Respiratory Journal, 61(6).
- Xi, Y., Zhang, W., Qiao, R.J. and Tang, J., 2022. Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis. PloS one, 17(6), p.e0270003
- García-García, J.M., Blanc, F.X., Buonsenso, D., Centis, R., Codecasa, L.R., D’Ambrosio, L., Goletti, D., Gualano, G., Kunst, H., Pontali, E. and Tadolini, M., 2022. COVID-19 hampered diagnosis of TB infection in France, Italy, Spain and the United Kingdom. Archivos de bronconeumologia, 58(11), p.783.
- World Health Organisation. 2025. Preventing Tuberculosis. Avialable at: https://www.who.int/activities/preventing-tb
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