On March 24, 2025, the world once again commemorated World Tuberculosis Day, marking 143 years since Dr. Robert Koch’s landmark announcement in 1882 of his discovery of the bacterium responsible for tuberculosis (TB). This annual observance aims to raise awareness about the enduring impact of the disease and reinvigorate efforts to eliminate the global TB epidemic. Though the first official World TB Day was celebrated in 1982, a full century after Koch’s discovery, the battle against TB remains far from over.

Despite major advances in medical science, TB continues to rank as the world’s deadliest infectious disease, responsible for immense health, social, and economic burdens—particularly in low- and middle-income nations. Its resurgence, especially in high-burden countries like Nigeria, reflects a complex intersection of longstanding systemic weaknesses, recent global disruptions, and emerging challenges.

TB: Symptoms, Spread, and Global Reach

Tuberculosis is a bacterial infection, primarily targeting the lungs. It presents with symptoms such as a persistent cough that may produce yellow or blood-tinged sputum, fever, weight loss, and night sweats. The disease spreads mainly through airborne droplets released during coughing or sneezing. However, it can also affect other organs—particularly in individuals with weakened immune systems or those exposed to contaminated animal products.

Globally, TB exists in every country, but it disproportionately afflicts low- and middle-income populations. Up to 25% of the global population has been exposed to TB, yet the majority remain undiagnosed or inadequately treated. While TB is preventable and treatable through antibiotics, its control is complicated by poverty, poor healthcare access, inadequate surveillance, and growing drug resistance.

Nigeria’s Worsening Burden: Infrastructure and Insecurity

Nigeria exemplifies many of the challenges that have led to the re-emergence of TB. The country’s healthcare system has long struggled with underfunding and workforce shortages. The recent mass emigration of healthcare professionals has left critical gaps in service delivery, particularly in rural and conflict-prone regions. In addition, persistent insecurity in the northern regions, alongside dilapidated infrastructure such as non-motorable roads and unreliable electricity, has contributed to a breakdown in basic health services.

One of the key infrastructural challenges involves cold-chain logistics, particularly for storing vaccines. When power supply is erratic or unavailable, entire communities may miss out on immunization, leaving children and vulnerable adults unprotected from TB and other vaccine-preventable diseases.

TB and Diphtheria: A Deadly Duo Among Children

A growing concern is the high toll TB and diphtheria are taking on Nigeria’s youngest population. Together, these two infections account for nearly a third of the top six killer diseases in children under five years old. This alarming statistic underscores the urgent need to address both diseases as part of a broader pediatric health strategy.

Root Causes of TB’s Resurgence

TB’s re-emergence is tied to a web of remote and immediate causes. Among the remote causes are:

• Weak healthcare systems: Many countries, including Nigeria, lack the robust infrastructure needed for effective TB detection, treatment, and follow-up.

• Rapid urbanisation: In fast-growing urban centers, overcrowded and unsanitary living conditions create fertile ground for TB transmission.

• Poverty and inequality: Economic hardship forces many to live in unhealthy environments and forgo medical care due to out-of-pocket costs. In Nigeria, the health insurance system remains fragmented and largely ineffective, pushing vulnerable groups further into health poverty.

• Globalisation and migration: Increased human mobility facilitates the cross-border spread of TB, often without effective monitoring mechanisms in place.

• The HIV/AIDS epidemic: Immunocompromised individuals, especially those living with HIV/AIDS, are significantly more vulnerable to TB infection.

• Animal contact: Consumption of unpasteurized milk from infected livestock can lead to gastrointestinal TB, further expanding the disease’s reach.

The Role of Stigma and Awareness Deficits

In traditional and rural communities, TB continues to be heavily stigmatized. Social perceptions of the disease as shameful often discourage individuals from seeking timely treatment, leading to increased transmission. Compounding the problem is the lack of effective public health campaigns and limited access to diagnostic tools in these areas, especially those affected by violence and displacement.

Multidrug Resistance and COVID-19: Double Jeopardy

Multidrug-resistant TB (MDR-TB) has emerged as a major global threat. Caused by inadequate or incomplete treatment, MDR-TB is more difficult and expensive to manage, with fewer effective drug options. This issue is particularly severe in settings with weak health systems, where patients struggle to adhere to prescribed regimens due to costs or stockouts.

The COVID-19 pandemic further exacerbated the TB crisis. With healthcare systems stretched thin, attention and resources were diverted to coronavirus response efforts, leading to widespread treatment interruptions and missed TB diagnoses. The result was a resurgence in TB transmission that the global community is still grappling with.

Global Funding Gaps and U.S. Withdrawal

Global efforts to control TB have saved an estimated 79 million lives since 2000. Yet recent political decisions threaten to reverse this progress. During the administration of former U.S. President Donald Trump, the United States significantly scaled back its international health funding, including contributions to the World Health Organization (WHO) and key multilateral health initiatives.

Although U.S. global health spending accounted for just 0.3% of its federal budget in 2023 (approximately $20.6 billion out of $6.1 trillion), this relatively small investment represented a large share of global health aid. The U.S. provided around 75% of international funding for HIV/AIDS, 40% for malaria, and over 33% for TB programmes.

The U.S. also played a leading role in the COVID-19 vaccine drive through COVAX and contributed to the Pandemic Fund under the World Bank, which supports health crisis preparedness in low-income countries. However, America’s retreat has left a funding vacuum that no other nation—including China—has stepped up to fill. This funding shortfall threatens to curtail outreach, testing, and treatment efforts in high-burden countries like Nigeria.

The Nigerian Context: From Displacement to Disease

In Nigeria, worsening insecurity, climate change, and poverty have led to mass displacement across the country’s northern belt. Displaced communities often live in overcrowded shelters with limited access to healthcare, poor sanitation, and inadequate nutrition—all of which contribute to the spread of TB. Malnutrition, in particular, weakens immunity and makes individuals more susceptible to infection.

Moreover, substance abuse and poor housing conditions also play critical roles in fueling TB outbreaks. Together, these factors—grouped under the umbrella of “health poverty”—create the perfect storm for TB transmission and reinfection.

The Way Forward: A Call for Urgent Action

Reversing the tide of TB’s resurgence requires coordinated and sustained global action. A multi-pronged approach must address both systemic and immediate causes. Key strategies include:

1. Strengthening healthcare systems: Investment in diagnostic tools, human resources, and supply chains is crucial.

2. Scaling up public awareness: Nationwide education campaigns can reduce stigma, promote early detection, and encourage treatment adherence.

3. Improving access to treatment: Making TB medications available and affordable must become a central policy goal, especially in underserved regions.

4. Boosting research and development: Funding for new vaccines and treatment options must be prioritized to combat drug resistance and improve outcomes.

5. Addressing social determinants of health: Interventions must go beyond medicine, tackling the root causes of vulnerability such as poverty, housing, malnutrition, and education.

6. Reviving global partnerships: High-income countries must recommit to funding global TB programmes to maintain and build on past successes.

Conclusion: A Preventable Tragedy Demands Preventive Action

Tuberculosis, though ancient, remains one of today’s most pressing public health challenges. Its persistent spread in countries like Nigeria reflects a broader failure to invest in equitable health systems and address socio-economic disparities. As TB once again climbs the list of global killers, the world must not ignore the warning signs. Political leaders, public health experts, and development partners must act with urgency and resolve to eliminate this preventable tragedy from the global health landscape.