World TB Day 2026: Progress Made, Gaps Remaining, and the Path Forward

By Dr. Tefera Azigew, MD, MPhil, PhD | APOPO Head of TB  

Tuberculosis (TB) is both preventable and curable, yet it remains the world’s leading infectious killer. Each year, it claims more lives than any other infectious disease, including HIV and malaria. On March 24, World TB Day highlights the progress achieved as well as the challenges that remain. Since 2000, global efforts have saved an estimated 83 million lives. Even so, TB continues to affect a vast portion of the world’s population, with serious consequences for health, livelihoods, and economies. This year’s theme, “Yes! We can end TB: Led by countries, powered by people,” reflects both urgency and possibility. It underlines that ending TB is achievable, but only with strong national leadership and sustained collective action. If TB is preventable and curable, why does it remain such a global threat? The answer lies in a set of persistent gaps. Millions of people with TB are never diagnosed or are diagnosed too late. Access to fast, accurate testing is still uneven, particularly in resource-constrained settings. TB is also closely linked to malnutrition, poverty, overcrowding, and limited access to healthcare, which makes it harder to control. In addition, treatment requires a long course of antibiotics, and interruptions can lead to drug-resistant TB, which is more difficult and costly to treat. These gaps define the challenge in 2026.

Progress made

There has been meaningful progress in recent years. In 2024, according to the WHO an estimated 10.7 million people fell ill with TB, and 1.23 million died. While the burden remains high, improvements in detection and treatment have helped reduce the number of people missed by health systems. An estimated 2.4 million cases went undiagnosed or unreported, a significant improvement compared to 4 million in both 2020 and 2021, and below pre-pandemic levels. APOPO’s TB detection programs are currently based in Tanzania and Ethiopia, and, in fact, these countries are a clear illustration of both the progress achieved and the challenges that remain.

• Tanzania has transitioned from a highly endemic to an endemic TB category between 2015 and 2024
• Ethiopia is no longer listed among the 30 high MDR/RR-TB burden countries

At the same time, TB notification rates in both these countries have been declining by around 5 percent annually. Global innovation is also moving forward. The World Health Organization (WHO) is calling for accelerated rollout of near point-of-care molecular diagnostic tests, alongside new approaches such as tongue swabs and sputum pooling to improve access and efficiency. Together, these developments signal real momentum.

Gaps remaining

Despite this progress, the pace of change is still not sufficient to meet global targets. By 2025, TB incidence and deaths, compared to 2015, had declined by 12 percent and 29 percent respectively, well short of the 50 percent and 75 percent targets set under the End TB Strategy. The most critical gap remains detection. Millions of people with TB are still missed each year, allowing the disease to spread. According to the WHO, one person with active pulmonary TB can infect 10 to 15 others annually. Delayed or missed diagnosis therefore has a direct impact on transmission. Diagnosis is also particularly challenging in certain groups. Children, for example, often have lower bacterial loads, making TB harder to detect with standard methods. At the same time, access to testing remains uneven, especially in settings with limited laboratory capacity. Closing these gaps is essential to accelerating progress.

APOPO’s contribution to closing the gaps

APOPO has been researching the use of African giant pouched rats (Cricetomys ansorgei) for TB screening since 2007 in Tanzania, Mozambique, and Ethiopia. As a Belgian non-governmental organization with a strong research focus, APOPO works to support international efforts and the WHO End TB Strategy for a world free of TB. Using trained detection rats, APOPO supports national TB programs by rapidly screening sputum samples and identifying cases that are missed by routine diagnostics. One rat can screen 100 samples in under 20 minutes. The same task can take a lab technician up to four days. All positive indications are confirmed in APOPO’s laboratory before results are returned to clinics, enabling patients to begin treatment as quickly as possible. By the end of 2025, APOPO’s TB detection program had:

• Screened 1,063,650 sputum samples from 682,958 individuals in Tanzania, Ethiopia, and Mozambique
• Identified 35,797 additional TB cases, over smear or Xpert MTB/RIF Ultra-based diagnostic algorithms, that were initially missed by routine screening
• Helped avert an estimated 384,009 potential infections, based on WHO transmission estimates

Each additional case detected represents not only a life changed, but a potential chain of transmission interrupted.

Innovation and evidence

APOPO’s approach has demonstrated strong added value alongside sputum smear microscopy, and more recently in settings using molecular diagnostics such as Xpert MTB/RIF and Ultra-based diagnostic algorithms, which are being adopted more widely in countries like Tanzania and Ethiopia. Emerging research also points to a promising role in detecting TB in children, where diagnosis is often more difficult. Detection rats have shown the higher odds of detecting TB in pediatric samples, even when bacterial loads are low. While further validation is needed, this could help address one of the most persistent diagnostic challenges in TB control.

The path forward

In 2026, the focus is increasingly on scaling what works and investing in new solutions. APOPO is expanding both its operational reach and research efforts:

• Geographic expansion in Tanzania, with operations now extended to four additional regions: Kilimanjaro, Arusha, Manyara, and Tanga
• 40 new health facilities integrated into the detection network
• A new collaboration in Uganda with the Mildmay Research Centre, with plans to initiate operations in 2026
• Continued research into non-sputum sample types, including sebum, urine, and breath, which are less invasive and more suitable for children
• Ongoing collaboration with the University of Manchester and other partners, including work involving “living biosensor” Joy Milne

These efforts reflect a broader shift toward more accessible, scalable, and patient-centered TB detection. Ending TB by 2035 remains an ambitious goal, but one that is still within reach. To achieve this, the rate of decline in TB cases must accelerate significantly, from around 5 percent annually to at least 15 percent. This will require faster detection, wider access to care, and sustained global commitment. APOPO’s work shows how combining scientific research with innovative approaches can help close critical gaps and accelerate progress. Yes, we can end TB, but only by closing the detection gap, scaling proven solutions, and investing in innovations such as those being developed by APOPO that help reach those still being missed.  

You can adopt TB-detection rat Tamasha and contribute towards ending TB.

APOPO is deeply grateful for the support and generosity of our partners and donors over the years including the health authorities in the countries it works.