Tuberculosis (TB) remains one of Europe's most serious infectious disease challenges, with health systems failing to catch roughly one in five cases before they spread. A new joint report from the World Health Organization (WHO) Europe and the European Centre for Disease Prevention and Control (ECDC) reveals that while TB incidence has dropped 39% since 2015, the region is still falling dangerously short of global elimination targets. The real crisis: undiagnosed patients continue transmitting TB in their communities, and many develop drug-resistant strains that are far harder to treat. Why Are So Many TB Cases Being Missed? In 2024, health systems across the WHO European Region reported 161,569 newly diagnosed TB cases from 51 of 53 countries. However, WHO estimates that approximately 204,000 people actually fell ill with TB that year. This gap means roughly 42,000 cases went undiagnosed or unreported. In the European Union and European Economic Area (EU/EEA) specifically, progress has stalled. While notification rates have stabilized, diagnostic gaps and inadequate follow-up persist due to limitations in healthcare systems. The consequences are severe. People who are diagnosed late have a higher chance of transmitting TB to others and are harder to treat. More TB transmission may result in high numbers of people with treatment failure, which is a primary driver of drug resistance. Closing the detection gap and tackling drug resistance are not separate problems; they are part of the same fight. How Is Drug-Resistant TB Becoming a Bigger Threat Than Globally? Europe faces a disproportionate burden of drug-resistant TB compared to the rest of the world. While globally only 3.2% of new TB cases are resistant to rifampicin (a key antibiotic), in Europe that figure jumps to 23%. For previously treated cases, the disparity is even starker: 16% globally versus 51% in Europe. This means Europe is seeing roughly seven times the global average for rifampicin-resistant cases and three times the global average for multidrug-resistant TB. In the EU/EEA alone, 3.5% of TB cases are multidrug-resistant, but treatment success for these cases is just 56%. Poor treatment outcomes allow drug-resistant strains to persist and spread, creating a vicious cycle. Across the entire European Region, there were 26,845 confirmed cases of rifampicin-resistant or multidrug-resistant TB in 2024. Drug-resistant strains require longer and more complex treatment regimens and are responsible for substantially higher mortality. What Are the Key Barriers to Better TB Detection and Care? Several interconnected challenges prevent Europe from reaching its TB elimination targets. One critical issue is follow-up care. One in five people who start TB treatment in the EU/EEA are not evaluated after one year, a gap that also affects children under 15 years of age. This lack of monitoring means treatment failures go undetected, allowing resistant strains to develop and spread. Additionally, TB disproportionately affects vulnerable and marginalized populations, including people in prison. An estimated 23,000 HIV-positive TB cases were recorded in the European Region, with 80% concentrated in the Russian Federation (52%) and Ukraine (28%). Despite high HIV testing rates among TB patients (93%), antiretroviral therapy coverage remains below WHO universal targets, leaving co-infected individuals at greater risk. Steps to Strengthen TB Detection and Treatment Across Europe - Scale Up Rapid Diagnostics: Intensify access to WHO-recommended rapid molecular tests that detect TB, including drug-resistant strains, more quickly and accurately than traditional methods. These near-point-of-care tests can be deployed in high-burden settings and marginalized communities. - Expand Shorter Treatment Regimens: Roll out all-oral treatment options for drug-resistant TB to improve patient outcomes and reduce loss to follow-up. Shorter regimens increase the likelihood that patients will complete treatment and prevent the development of further resistance. - Strengthen Integration of TB and HIV Services: Improve coordination between TB and HIV treatment programs, ensuring that co-infected individuals receive both antiretroviral therapy and TB treatment simultaneously, with robust follow-up at one year and beyond. - Focus on High-Risk Populations: Prioritize early case detection in prisons, among people experiencing homelessness, and in other marginalized communities where TB transmission is highest and healthcare access is most limited. - Improve Surveillance and Reporting: Strengthen data collection on HIV co-infection, TB in prisons, and treatment outcomes to support evidence-based policy making and identify gaps in care delivery. The WHO and ECDC are calling on European governments and institutions to act urgently on these fronts. The evidence is clear about what works; the challenge now is implementation and sustained political commitment. What Would Success Look Like? Europe's TB incidence has fallen by 39% and deaths by 49% since 2015, but both figures fall well below the End TB Strategy's 2025 milestones of 50% and 75%, respectively. Within the EU/EEA, TB cases have decreased by 33% and deaths by 17%, but most EU/EEA countries will not achieve their 2030 targets, resulting in thousands of new infections and deaths that could be prevented. Globally, the message is clear: ending TB is achievable if countries act now. The WHO emphasizes that every dollar invested in TB can generate up to $43 in health and economic returns. This is not just a health imperative; it is a strategic economic decision. Bringing TB services closer to communities, rapidly expanding access to new diagnostic tools in an environment free of stigma, and delivering people-centered care are essential to reaching everyone in need and protecting hard-won progress. "One in five people with TB in the European Region are still being missed by health services. That is not only a failure in detection; it is a missed chance to treat earlier, prevent suffering and stop further transmission," said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe. Dr. Hans Henri P. Kluge, WHO Regional Director for Europe The path forward requires sustained domestic investment, stronger political commitment, and empowerment of health workers to combat stigma and ensure essential TB services remain accessible and resilient across the region.
