The Forgotten Killer: Tuberculosis is Back on the Rise

Photo by Devana Jalalludin courtesy of Unsplash

As of January 2025, more than 60 cases of tuberculosis (TB) have been confirmed in Kansas City. While not a major threat, the outbreak has sent alarm bells ringing throughout the American healthcare system, raising concerns around national health and safety, the dangers of TB, and the state of global infectious disease treatment today. Despite the existence of a vaccine and effective treatment protocols, the global TB infection rate has continued to rise over the last five years, with 1.5 million people dying in 2023 from the disease. This surge in TB has restored the disease as the “world’s leading cause of death from a single infectious agent,” surpassed only by COVID-19 in 2020.  

The vast majority of TB is isolated in the global south, with South Africa and India contributing to 37% of the world’s documented tuberculosis cases. Both countries face systematic challenges in delivering available treatments to citizens, suggesting the existence of greater underlying mechanisms facilitating the progression of the disease. Unregulated privatization of Indian healthcare and the subsequent lack of quality control means that over 2.2 million TB patients receive substandard care that is diagnostically correct only 13% of the time. Even when patients are treated in the public sector, the preferential treatment is broad-spectrum antibiotics and non-specific therapies, expediting TB progression. South Africa’s TB epidemic, on the other hand, stems from a failure to treat HIV. Untreated, HIV progresses into AIDS, a condition which deteriorates the host’s immune defense. About 13% of South Africa’s population is HIV-positive, with only 56% of those receiving antiretroviral therapy, which blocks the development of HIV into AIDS. As a result, South Africa has one of the largest populations of immunocompromised individuals, ultimately leading to one of the highest TB mortality rates of any country with a significantly developed health infrastructure.

These statistics confirm TB’s status as the world’s deadliest infectious disease. Despite the development of the moderately effective Bacille Calmette-Guerin (BCG) vaccine in 1919, TB remains a persistent global challenge, especially for marginalized communities. Global TB vaccine shortages have been estimated to cause an additional 1.5 million deaths over a 15 year period, due to lack of access to suppliers and affected BCG vaccine production. This trend suggests that recent upticks in TB are a result of treatment fatigue —  a condition which involves the systematic failure to administer reputed treatments. A small yet substantial increase in TB rates domestically implies that this treatment fatigue has infiltrated the United States.

Dr. Najam Zaidi, assistant professor of infectious disease at Brown University, describes the January outbreak as a “small scale public health failure,” likely to worsen under recent cuts to American Healthcare infrastructure. In March 2025, U.S. Secretary of Health and Human Services, Robert F. Kennedy Jr., announced the downsizing of 10,000 personnel, mostly from the Food and Drug Administration and Centers for Disease Control. The announcement came shortly after the Trump administration cut 12 billion dollars of funding to state health services, which according to the New York Times, were “being used for tracking infectious diseases” among other vital public health concerns.

On February 12, 2025, the Kansas City Department of Health and Environment issued an update on their regional TB outbreak, reporting 67 active infections with two documented deaths. Regarding this scare, Dr. Zaidi commented “if you allot the proper resources, it doesn’t get out of hand,” referring to the six week long antibiotic regimen which reliably cures latent TB infection. He elaborated that management of TB is uncomplicated in its latent form, only becoming dangerous and costly when it is allowed to fester. Although he clarified that this incident does not warrant serious fear about an epidemic, he did assert that TB anywhere is a U.S. failure and that the only way to protect Americans from the disease is to eradicate it completely. Zaidi believes that institutions like the World Health Organization and American Red Cross could be doing much more to distribute therapies and educate global healthcare workers about salient TB treatment.

With its robust medical and humanitarian infrastructure, the United States is positioned to improve access to accurate medical education, expand treatment distribution networks, and contribute to the global effort to reduce the burden of this disease. The WHO has proposed an increase in U.S. investment in tuberculosis screening and preventive treatment. These investments are projected to yield significant economic benefits with an estimated return of $39 for every $1 invested. With the resources already in hand, ending the world’s TB burden is no longer a question of possibility, but of resolve. It simply requires the initiation of aggressive preventive measures and adoption of proactive policy proposals. In the words of Dr. Zaidi, “we can beat this;” the only question that remains is: will we?