Tuberculosis (TB) continues to be a significant public health concern across the European region, with a concerning one in five cases going undiagnosed, according to a recent report from the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). While the overall number of reported cases has seen a decline, progress towards the ambitious goal of TB elimination is proving insufficient, particularly due to persistent drug resistance.
Tuberculosis, a bacterial infection that primarily affects the lungs but can impact other parts of the body, remains the leading cause of death globally from a single infectious agent. It spreads through the air when an infected individual with pulmonary TB expels bacteria during coughing. Symptoms can vary, but commonly include a persistent cough lasting over two weeks, fever, night sweats, and unexplained weight loss.
Progress and Shortfalls in TB Reduction
Across the expansive WHO European Region, which comprises 53 countries in Europe and Central Asia, the incidence of TB has fallen by 39 percent since 2015, and the number of deaths has decreased by 49 percent. However, these figures fall short of the WHO’s End TB Strategy’s 2025 targets, which aimed for a 50 percent reduction in incidence and a 75 percent reduction in deaths.
Within the European Union specifically, cases have decreased by 33 percent and deaths by 17 percent. While a reduction, this is not enough to meet the region’s 2030 targets, leading to what health agencies describe as “thousands of new infections and deaths that could have been prevented.”
The Challenge of Undiagnosed Cases
In 2024, over 160,000 new TB cases were officially reported in the region. However, the estimated actual number of cases was around 204,000, indicating that only 79 percent of estimated new and relapsed cases were notified. Hans Kluge, WHO Regional Director for Europe, highlighted the gravity of this situation. He stated that undiagnosed cases represent not only a failure in detection but also a missed opportunity to initiate treatment early, alleviate suffering, and halt further transmission of the disease.
“By investing in rapid diagnosis, shorter all-oral treatment regimens and stronger follow-up, countries can reach more people earlier, improve outcomes and put us back on track toward our targets,” Kluge urged. The report emphasizes that delayed diagnosis not only makes treatment more challenging for the infected individual but also significantly increases the risk of spreading the infection to others.
The Growing Threat of Drug-Resistant Tuberculosis
A major hurdle in the fight against TB in Europe is the persistent challenge of drug-resistant strains. The report reveals that multi-drug resistant tuberculosis (MDR-TB) among new cases stands at 23 percent, and for previously treated cases, it is a staggering 51 percent. These figures substantially exceed the global averages of 3.2 percent and 16 percent, respectively.
The high prevalence of drug resistance, particularly among patients who have undergone prior treatment, is a stark indicator of ongoing transmission. Standard treatment for non-resistant TB typically involves a six-month regimen of four first-line drugs, achieving success rates above 85 percent. In contrast, antibiotic-resistant variants necessitate longer, more complex treatment plans with a greater number of drugs, and are associated with considerably lower success rates.
Vulnerable Populations and Shifting Focus
Many European countries are classified as low-incidence regions for TB, with notification rates below 10 per 100,000 population. In these areas, TB disproportionately affects vulnerable groups, including migrants, prison inmates, and individuals coinfected with HIV.
Ralf Otto-Knapp, from the German Central Committee against Tuberculosis, who was not involved in the report, noted that the declining case numbers in Western Europe may be diverting attention away from the disease. This shift in focus, he warned, could make it more challenging to combat new instances of multidrug-resistant tuberculosis.
“We must be prepared for this by strengthening treatment and prevention services, ensuring easy access to new medicines and fostering cross-border cooperation,” Otto-Knapp advised, underscoring the need for sustained vigilance and collaborative efforts to effectively tackle this enduring public health threat.
