WHO report highlights stalled global progress, persistent diagnosis gaps, and the urgent need for stronger national commitment amid rising drug-resistant strains.
TIL BDR GHALLEY | Thimphu
Bhutan remains among the countries with a moderate but persistent tuberculosis (TB) burden, according to the Global Tuberculosis Report 2025, which places the country in Category 3, defined as an incidence rate between 100 and 299 cases per 100,000 population in 2024.
This classification situates Bhutan among other South-East Asian nations such as Bangladesh, India, Nepal and Thailand, indicating that the region continues to carry one of the highest proportions of TB cases.
The report warns that progress in fighting tuberculosis (TB) is stalling worldwide, with millions of people still undiagnosed and a surge in drug-resistant strains placing additional pressure on already fragile health systems. The report highlights that, despite notable efforts, “42 percent of cases are still going undiagnosed globally” TB, underscoring the widening gap between targets and actual outcomes.
The WHO stresses that although global indicators are moving in the right direction following pandemic-related disruptions, progress is still not fast enough. Report lead author Katherine Floyd emphasized that “TB remains a major global public health problem and progress in reducing the burden of disease falls far short of 2030 targets in most parts of the world,” while WHO infectious diseases director Tereza Kasaeva warned that “changes in the funding landscape threaten this progress.”
Within the South-East Asia Region, declines in TB mortality and incidence have trailed behind those in the African and European regions.
The report shows that between 2015 and 2024, TB mortality in the region decreased by 23%, significantly lower than the 46% drop in the African Region and the 49% reduction in the European Region.
For Bhutan, this regional picture underscores the need to sustain strong public health vigilance despite having a smaller overall population and stronger health systems than several regional neighbours. While the country is not considered highly endemic, its placement in the “endemic” category demonstrates that TB remains a major public health concern requiring continued investment, surveillance and community engagement.
Globally, the WHO reported that 10.7 million people fell ill with TB in 2024 and 1.23 million died, confirming TB’s position as one of the world’s top infectious killers.
One of the most significant findings with direct implications for Bhutan is that about 50% of TB-affected households worldwide face catastrophic costs—defined as TB-related expenses exceeding 20% of annual household income—even when treatment is provided free of charge. In Bhutan’s geographically dispersed and predominantly rural setting, such costs can include travel to health facilities, loss of income during long treatment regimens and nutritional needs for recovery.
The report notes that “reducing this economic burden requires faster progress towards universal health coverage and better levels of social protection,” reflecting a global concern that economic vulnerability continues to impede TB care access and treatment completion.
The WHO also highlights that global progress on drug-resistant TB remains fragile, with only 42% of rifampicin-resistant TB cases worldwide receiving treatment in 2024. While Bhutan detects and treats far fewer drug-resistant cases compared with high-burden neighbours, WHO stresses that every country must maintain strong diagnostic capacity to prevent the undetected spread of resistant strains.
WHO guidelines released in 2024 and 2025 emphasize expanding access to rapid molecular testing and implementing shorter all-oral treatment regimens. The agency noted that it now recommends “all-oral shorter-duration treatment regimens for people with drug-resistant TB,” reflecting the most recent evidence on effective management.
The report also calls attention to the broader determinants that drive TB incidence globally: undernutrition, diabetes, HIV infection, smoking and alcohol use disorders. These factors remain relevant for Bhutan, particularly in rural and low-income households where nutritional challenges persist and alcohol misuse continues to affect sections of the population. The WHO underscores that addressing these determinants is essential for reducing new infections and preventing disease progression among those already infected.
Policy recommendations implicit in the WHO’s findings suggest multiple areas for strengthened action in Bhutan. The report notes that countries should enhance early detection through expanded screening and rapid molecular diagnostics, reflecting commitments made at the 2023 UN High-Level Meeting on TB to integrate TB services fully into primary healthcare.
WHO further calls for the expansion of TB preventive treatment for household contacts and high-risk groups, emphasizing the need to “scale up comprehensive efforts to close longstanding gaps in prevention.” The same UN meeting urged governments to strengthen social protection frameworks and ensure that people affected by TB are not pushed into poverty, aligning closely with Bhutan’s national push toward universal health coverage.
The WHO stresses that global funding cuts make domestic political commitment more critical than ever, noting that without sustained national financing and community engagement, progress toward global TB targets remains at risk.
WHO reiterates that ending TB requires political commitment at every level.Dr Tedros Adhanom Ghebreyesus Director-General World Health Organization underscored this in his message accompanying the report, stating, “Ending TB requires shared responsibility, predictable financing, and coordinated action at global and national levels.” His remarks reflect the report’s central argument that global targets will remain out of reach without substantial and sustained investment in TB services.
The report noted that national and global progress will depend on rapid adoption of innovative tools, enhanced surveillance, and stronger political will. Without these measures, WHO warns that TB will continue to claim lives and strain health systems worldwide. For all member states, including Bhutan, accelerating case detection, improving diagnostic coverage, and sustaining investment remain central to achieving the End TB Strategy targets and preventing further setbacks in the global battle against tuberculosis.
