Solving the tuberculosis puzzle

The bacteria that cause tuberculosis have been known since 1882 and an effective treatment was developed decades ago. And yet TB remains the world’s deadliest infectious disease.

The implications of this stubborn public health puzzle are dire. In 2024, an estimated 10.7 million people fell ill with TB, but only about 8.3 million were diagnosed. Many of those who go undiagnosed eventually die from the disease. Many more unknowingly spread it.

This diagnostic gap — the difference between confirmed and estimated TB cases — is the greatest barrier to an effective global response. Some see this as a technical constraint, but it is not. The tools to detect TB rapidly and accurately now exist and, crucially, can be deployed far closer to where people first seek care, allowing for same-day treatment.

The tools to detect TB rapidly and accurately now exist and can be deployed far closer to where people first seek care

Anafi Mataka and Sharonann Lynch

Near-point-of-care molecular tests, which the World Health Organization recently recommended for the first time, represent a new and important tool. They are small, portable and use easy-to-collect tongue swabs, rather than the phlegm samples that many people — particularly children and those with HIV — struggle to produce. And they are more affordable than other types of molecular tests and instruments.

Equally important, near-point-of-care tests produce results in about 30 minutes, unlike traditional lab tests, which require days or weeks to turn around. This means they can be used for same-day diagnosis in primary care facilities, such as the community healthcare centers that are typically closer to where people live. The testing equipment is battery-powered, meaning patchy national grids need not limit access to lifesaving care.

With the Global Fund to Fight AIDS, Tuberculosis and Malaria starting its next funding cycle imminently, eligible countries have an opportunity to secure substantial resources for rolling out and scaling up this new technology. Governments that present detailed roadmaps — including a breakdown of costs, strategies for integrating near-point-of-care tests into national TB plans and measurable coverage targets — are far more likely to unlock support. Those that fail to act will have to wait three years for the next funding cycle. In global health, timing is often as important as evidence.

A slow rollout is indefensible, given the high human cost. Every day, TB spreads quietly and persistently. Delayed diagnosis does not just postpone treatment, it also causes suffering for millions of people by increasing transmission, raising mortality and accelerating drug resistance. Each untreated case represents an individual tragedy that augurs more untreated cases, adding to the public health burden.

Harnessing the potential of near-point-of-care testing requires significant political support for a rapid rollout

Anafi Mataka and Sharonann Lynch

Global health is full of examples of innovations that took decades to reach scale. For example, even though better-performing molecular TB tests were endorsed more than a decade ago, microscopy testing, a century-old technique that misses a substantial share of cases, remains widely used.

Harnessing the transformative potential of near-point-of-care testing requires significant political support for a rapid rollout. That appears to exist on paper. At the UN High-Level Meeting on the Fight Against Tuberculosis in 2023, governments committed to achieving universal access to rapid molecular TB tests by 2027. But in several regions with a high disease burden, only a minority of countries are on track to meet that target.

Near-point-of-care technology could help close the gap between ambition and reality by decentralizing TB testing. Primary healthcare facilities and lower-tier testing centers that still rely on microscopy, especially in rural areas, are obvious candidates for upgrading to near-point-of-care tests, as are high-volume treatment units.

Beyond accelerating the initial rollout of these diagnostics, policymakers must provide training for clinicians, ensure their integration into HIV and community health programs, and strengthen supportive systems such as supply chains and data management. A rapid test is merely the start of a care pathway; without system-wide preparedness, technological gains could be squandered. Past rollouts have faltered not because the science was weak but because health systems were not ready.

To translate rhetoric into reality, transparency and accountability will be essential. National roadmaps must include measurable milestones, standardized scorecards and meaningful reporting mechanisms. Civil society organizations, often the most effective advocates for underserved patients, must be involved in monitoring progress.

Previous global health campaigns have made it clear that technology can save lives only when it is matched by political ambition. This is the other missing piece of the TB puzzle. To eliminate the scourge of TB once and for all, developing country leaders must be willing to accelerate the uptake of near-point-of-care tests.

• Anafi Mataka is Head of Division at the African Society for Laboratory Medicine.
• Sharonann Lynch is Co-Director of the Center for Global Health Policy and Politics at Georgetown University.

Copyright: Project Syndicate