Rising Concerns Over TB in South Africa
According to the latest estimates from the World Health Organization (WHO), approximately 54,000 people died of tuberculosis (TB) in South Africa in 2024. Additionally, around 249,000 individuals were newly infected with the disease during the same year. These figures, released alongside the WHO’s latest World TB Report, highlight a continued but gradual decline in TB-related deaths over recent years.
Two decades ago, during the peak of the HIV epidemic, TB was responsible for roughly 200,000 deaths annually in the region. The two diseases are closely interconnected, as uncontrolled HIV significantly increases the risk of developing TB. As South Africa expanded its HIV treatment programs, there was a corresponding reduction in TB cases. In 2024, 29,000 of the TB deaths occurred among individuals living with HIV, while 25,000 occurred in those who were HIV-negative.
The number of new TB infections is also on a downward trend. In 2024, 249,000 people were diagnosed with TB, compared to 270,000 in 2023 and 292,000 in 2022. This marks a significant decrease from two decades ago when the annual number of new TB cases often exceeded 600,000.
Despite these improvements, a major challenge remains: not all individuals with TB are receiving timely diagnosis and treatment. In 2024, approximately 184,000 people were diagnosed with TB, representing 74% of the 249,000 who fell ill. This means that an estimated 65,000 individuals who contracted TB did not receive a diagnosis or appropriate treatment.
To address this issue, the South African government has set an ambitious target of conducting five million TB tests between April 2025 and March 2026. However, data obtained through a public information request indicate that only 1.75 million tests were conducted between April and September 2025. This suggests that the government may not meet its target. Nevertheless, it appears that more TB tests will be performed in 2025 than in any previous year in the last decade.
Uncertainty in TB Data
The WHO’s estimates come with relatively wide confidence intervals, indicating a degree of uncertainty. For example, the actual number of people falling ill with TB is estimated to range between 155,000 and 365,000. These broad ranges suggest that the accuracy of the data is limited, and further research is needed to refine these numbers.
The WHO’s findings align closely with those of Thembisa, a leading mathematical model used to estimate TB trends in South Africa. According to the most recent Thembisa estimates, published in 2024, there were approximately 62,000 TB deaths in adults between mid-2023 and mid-2024. This figure is slightly higher than the WHO’s estimate and does not include children. New Thembisa estimates are expected soon.
However, the WHO and Thembisa’s figures differ significantly from those reported by Statistics South Africa (StatsSA). StatsSA recorded around 20,000 TB deaths in 2022—the most recent year for which data is available. This discrepancy can be explained by the fact that StatsSA’s figures are based on death certificates, which often underreport TB and HIV. In contrast, the WHO and Thembisa use modeled estimates derived from multiple data sources, providing a more comprehensive picture of the true burden of TB.
Global TB Trends
Globally, TB remains a major public health threat. In 2024, an estimated 1.23 million people died from the disease, making it the leading cause of death from a single infectious agent. Around 10.7 million people were newly infected with TB, of whom 8.3 million were diagnosed.
India continues to be the epicenter of the global TB epidemic, accounting for 25% of all TB cases in 2024. Other countries with high TB burdens include Indonesia, the Philippines, China, and Pakistan. While these nations have larger absolute numbers of TB cases, South Africa has one of the highest rates of TB per 100,000 people—389 per 100,000, placing it 12th globally.
South Africa is also listed among countries with a high burden of drug-resistant TB. In 2024, an estimated 14,000 cases of drug-resistant TB were reported.
Funding Challenges
The WHO’s report highlights ongoing concerns about funding for TB prevention, diagnosis, and treatment. In 2024, global funding for these efforts amounted to $5.9 billion, far below the target of $22 billion by 2027. Similarly, TB research funding reached $1.2 billion in 2023, well short of the $5 billion goal.
Recent cuts to health-related aid from the United States in 2025 have exacerbated these challenges. Dr. Tereza Kasaeva, Director of the WHO’s Department for HIV, TB, Hepatitis and STIs, warned that long-term funding cuts could lead to up to 2 million additional TB deaths and 10 million new infections between 2025 and 2035. She emphasized the importance of both international and domestic investment in combating TB.
