Ending tuberculosis in the WHO South-East Asia Region: reflections and the road ahead in the milestone year of 2025
Overview
Tuberculosis continues to be a major public health and development challenge in the WHO South-East (SE) Asia Region, which accounted for more than 45% of the global TB burden in 2023. The year 2025 marks a critical milestone under the WHO End TB Strategy, providing an opportunity to assess regional progress, highlight persistent gaps and prioritize the actions needed to achieve the TB-related Sustainable Development Goals (SDGs) by 2030. This report presents an overview of the Region’s performance, informed by the latest epidemiological data, policy commitments and innovative interventions implemented by Member States.
While progress has been achieved, the Region remains significantly off track, insofar as meeting the 2025 milestones of the End TB Strategy is concerned. Between 2015 and 2023, TB incidence declined by just 6.7%, well below the milestone of a 50% reduction. TB deaths fell by only 11%, compared with the milestone of 75% reduction. In addition, catastrophic costs due to TB continue to burden many households, underscoring persistent financial vulnerabilities. These shortfalls reflect a range of systemic, socioeconomic and operational challenges that hinder the speed and scale of TB responses in many countries.
The Political Declaration adopted during the 2023 United Nations High-Level Meeting (UNHLM) on TB reaffirmed the global commitment to ending TB by 2030. The Declaration established ambitious targets for the 2023–2027 period, encompassing diagnosis and treatment of at least 90% of people with TB – this means attending to 45 million individuals, including 4.5 million children and 1.5 million individuals with drug-resistant TB (DR-TB). It also called for TB preventive treatment (TPT) for 90% of people at high risk, including 30 million household contacts and 15 million people living with HIV (PLHIV), while ensuring financial protection for all TB-affected families and raising the annual TB funding to US$ 22 billion by 2027.
Despite the demonstration of political will, multiple challenges persist in achieving the TB-related goals. Disease detection remains suboptimal, with approximately 22% of people with TB remaining undiagnosed or unreported. Although TB treatment coverage reached 78% in 2023, countries need to adopt innovative strategies to reach the missing millions. Expanding the use of WHO-recommended molecular rapid diagnostic tests, deploying artificial intelligence (AI)-enabled chest X-rays and undertaking active case-finding among high-risk groups, such as prisoners, migrants and urban poor populations, remain critical. Integrating TB screening into general health services and enhancing public–private partnerships will further help bridge diagnostic gaps.
DR-TB remains a major challenge. Only 44% of the estimated DR-TB cases were diagnosed and treated in 2023, with the bulk of the burden concentrated in India, Indonesia and Myanmar. Universal drug susceptibility testing and scale-up of shorter, all-oral regimens, such as bedaquiline, pretomanid and linezolid (BPaL) and bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM), are needed, along with investment in laboratory infrastructure and patient support systems.
Childhood TB detection also remains inadequate, with only 49% of estimated child TB cases diagnosed and treated. Diagnosis is hampered by non-specific symptoms, limited access to paediatric TB diagnostic tools and lack of trained personnel. Strategies to address this include the use of stool samples for molecular testing, upfront chest X-Ray screening, child-friendly diagnostic algorithms and training paediatric providers.
TPT is another underutilized intervention, particularly among household contacts and PLHIV. Despite evidence of its effectiveness, TPT coverage remains low across the Region. Innovations such as integrating TPT with HIV services, using shorter regimens such as 3HP, and involving community health workers for follow-up can improve uptake and completion rates.
Social protection remains an essential yet under-implemented aspect of TB care. Though TB services are free in the public sector, indirect costs and income loss continue to impose catastrophic burdens on patients. Conditional cash transfers, food baskets, transport support and psychosocial care can significantly improve treatment adherence and outcomes. However, gaps persist in coverage, integration, funding and access, especially for vulnerable groups and those in the private sector.
Psychosocial care remains a neglected component of TB services in the Region, despite the high mental health burden experienced by patients. Stigma, isolation and treatment-related stress often go unaddressed due to limited integration of counselling or support systems into TB programmes. Few countries offer systematic screening or sustained psychosocial interventions. Expanding patient-centred care must include mental health support to improve treatment adherence and outcomes.
Community engagement in TB programmes across the Region is often limited to passive awareness efforts instead of meaningful participation. Most countries lack structured mechanisms to involve communities in programme design, implementation or monitoring. Without sustained investment and recognition of communities as equal partners, TB responses risk being top-down and ineffective. Empowering communities through co-creation and accountability can enhance reach, trust and equity.
Research and innovation are critical drivers for ending TB in the Region. The development and scale-up of next-generation diagnostics, safer and shorter treatment regimens, and new TB vaccines are needed to overcome current limitations. Operational research also plays a key role in identifying optimal delivery models, addressing implementation barriers and informing policy. Regional capacity-building, funding mobilization and knowledge-sharing must be strengthened to accelerate innovation.
Finally, funding remains a fundamental constraint. Many countries continue to rely heavily on external donor support, with over 50% of TB budgets in Bangladesh, Indonesia, Myanmar and Nepal projected to be unfunded in 2024. Funding disruptions, such as the withdrawal of the United States Agency for International Development (USAID) support, threaten the sustainability of key TB interventions. Increasing domestic investment and exploring innovative financing mechanisms – such as sin taxes, social impact bonds and results-based financing – are urgently needed to ensure sustainable and equitable TB services.
In conclusion, ending TB in the WHO South-East Asia Region requires a comprehensive, multisectoral approach, grounded in strong political leadership, sufficient financing, technological innovation, community engagement and equity. Countries must urgently scale up proven interventions, address persistent gaps and ensure that every person affected by TB has access to quality care, financial protection and support. The Region’s progress is essential to achieving global TB elimination goals and safeguarding the health and well-being of its populations.
