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Global tuberculosis epidemic: progress, challenges and Cambodia’s journey towards 2030

Posted on by Larry
Global tuberculosis epidemic: progress, challenges and Cambodia’s journey towards 2030

As the world struggles to meet its goal of ending tuberculosis (TB) by 2030, the disease remains one of the leading infectious killers worldwide, mainly affecting low- and middle-income countries.

The World Health Organization’s (WHO) Global Tuberculosis Report 2024, published at the end of October, indicates both hopeful progress and major challenges in the fight against tuberculosis.

Cambodia, a high-burden country, is an example of the global fight against tuberculosis and has made significant progress in reducing the incidence of the disease over the past two decades. However, the country still faces challenges that could hinder the achievement of the 2030 target.

Chuob Sok Chamroeun, executive director of the Khmer HIV/AIDS NGO Alliance (KHANA), said that in line with the WHO’s vision of a “world free of tuberculosis”, Cambodia has drawn up its own strategic plan.

Chamroeun noted that “WHO’s goal is to reduce tuberculosis deaths by 90 percent and tuberculosis incidence by 80 percent compared to 2015 levels by 2030.”

Presenting key facts, he underlined tuberculosis as the “infectious cause of death worldwide” and emphasized the need for consistent efforts to detect and treat all cases.

He emphasized the airborne nature of the disease, saying it could affect “anyone, anywhere.”

According to the WHO report, an estimated 10.8 million people worldwide became ill with tuberculosis in 2023, while the number of officially reported and diagnosed cases was 8.2 million. This represents a slight increase compared to previous years and a 15 percent increase compared to pre-pandemic levels.

The incidence rate, or new cases per 100,000 people, increased only marginally by 0.2 percent between 2022 and 2023, indicating a stabilization in the number of new cases.

Dr. Tereza Kasaeva, Director of the WHO Global Tuberculosis Programme, stressed: “The global fight against tuberculosis requires steadfast commitment. Despite pandemic-related setbacks, we are witnessing strong recovery efforts that offer hope.”

The incidence of tuberculosis is most concentrated in the 30 hard-hit countries, which account for 87 percent of global cases. Five countries – India, Indonesia, China, the Philippines and Pakistan – together account for more than half of the global cases.

The WHO End TB Strategy, launched in 2015, set targets to reduce tuberculosis incidence by 50 percent and tuberculosis-related deaths by 75 percent by 2025, compared to 2015 levels.

However, global reductions have fallen short, with only an 8.3 percent decline in incidence and a 23 percent decline in mortality by 2023.

Cambodia: An example of steady progress

Cambodia’s experience with tuberculosis reflects both the gains and setbacks that characterize the broader fight against the disease in Southeast Asia.

In the early 2000s, the incidence of tuberculosis in the country exceeded 500 cases per 100,000 inhabitants.

Aggressive programs and international support have steadily reduced this figure, to 320 per 100,000 by 2022.

The Global Tuberculosis Report 2024 highlights that Cambodia remains on the global TB watchlist, which focuses on countries that require continued attention to prevention and control.

The launch of an e-counseling initiative and comic book on the tuberculosis program at Sunway Hotel in Phnom Penh in May 2019. Postal staff

A major milestone for the country was the completion of its third national tuberculosis prevalence survey in July 2024, which aims to update incidence estimates and provide crucial data that will inform tuberculosis control strategies and guide the country’s efforts to achieve WHO goals.

The final results are expected to be included in the 2025 TB report, which will make policy adjustments alongside the WHO’s broader observations. With global TB incidence showing only a small increase in 2023, this indicates a trend towards stabilization.

These cuts underline the country’s success in expanding tuberculosis diagnostic services, improving access to treatment and implementing WHO’s Directly Observed Treatment, Short-Course (DOTS) strategy, where a healthcare worker observes how a patient swallows the prescribed medications.

The National Tuberculosis Program (NTP) has played an important role in tuberculosis control, providing free treatment services and screening and treating high-risk populations, including people living with HIV.

WHO Director-General Dr Tedros Adhanom Ghebreyesus highlighted the broader challenge, stating: “TB is the definitive disease of deprivation. Tackling tuberculosis means not only curing the disease, but also tackling the social determinants that promote its spread.”

However, Cambodia still faces numerous obstacles. A major challenge is ensuring continued access to TB services in rural areas, where healthcare infrastructure is limited.

Additionally, because tuberculosis remains stigmatized in many communities, individuals may hesitate to seek timely diagnosis and treatment, increasing the likelihood of transmission.

“A slight increase in incidence rates observed in recent years could reflect residual effects of Covid-19 as healthcare resources were strained and disruptions affected TB services,” the report said.

Regional comparison and objectives

Regionally, Southeast Asia accounts for nearly 45 percent of global tuberculosis cases, with high incidence rates in Cambodia, the Philippines and Indonesia.

The WHO Southeast Asia region has experienced modest declines in incidence, but like Cambodia, other countries face obstacles that threaten progress.

“Despite these challenges, the Southeast Asian region remains committed to the WHO’s End TB Strategy, which calls for significant reductions in tuberculosis incidence and mortality by 2025 as intermediate milestones towards eradication by 2030,” the report said.

The WHO Western Pacific Region, which includes Cambodia, has also suffered setbacks in tuberculosis elimination due to the pandemic.

According to the report, countries in this region are increasingly focusing on tuberculosis prevention, rapid diagnosis and treatment of drug-resistant tuberculosis.

Financing and the road ahead

Achieving tuberculosis eradication by 2030 remains a major challenge given the financial and structural constraints we face worldwide.

WHO’s goals include mobilizing US$22 billion per year by 2027 for TB services and an additional US$5 billion per year for research.

Currently, funding lags far behind these figures, with only $5.7 billion raised in 2023.

Kasaeva noted: “A major barrier in the fight against tuberculosis is the lack of sufficient funding. We need a collective commitment to translate promises into resources and actions.”

Cambodia, which relies on international aid for TB services, needs continued financial support to make progress.

The country’s success with DOTS offers hope for other high-burden countries; However, achieving the 2030 target will require accelerated efforts, substantial financing and improved social protection.

USAID Administrator Samantha Power commended the country for its achievements in eradicating tuberculosis and malaria.

At a press conference on October 23 in Phnom Penh, Power said USAID’s focus is on the elimination of tuberculosis.

“Cambodia is working toward the goal of eliminating tuberculosis by 2030, and USAID has committed an additional $4 million to support local community efforts,” she said.

Furthermore, the development and distribution of a new TB vaccine, expected within the next five years, could be a game changer.

Until then, preventive measures, diagnostic improvements and ensuring access to medication remain top priorities.

The country’s progress in reducing tuberculosis incidence is encouraging, but the road to 2030 is fraught with challenges.

“In Cambodia, we have the National Center for Tuberculosis and Leprosy Control (CENAT) which plays a key role in ensuring that tuberculosis elimination targets are achieved,” Chamroeun said.

Global reductions in tuberculosis incidence and mortality are still far from WHO milestones, and while Cambodia has made commendable progress, a resurgence in cases could derail gains.

Dr. Kasaeva’s call for unity resonates strongly in this context: “Only through our collective determination can we end tuberculosis once and for all.”