Each year, over 10 million people worldwide get ill from tuberculosis (TB) and 1.25 million die from the disease, more than from any other single infectious agent.
Drug-resistant TB, which is challenging to treat, is on the rise in the Western Pacific region, of which Australia is a part. Stewardship of available second- and third-line antibiotic medications, and research and development of alternative drugs are needed to ensure the continued availability of effective treatments for TB.
Why does tuberculosis remain a threat to the region?
TB is a highly contagious disease caused by Mycobacterium tuberculosis infection. Globally, TB is the number one killer of humans from a single infectious agent. The latest estimates from the World Health Organization (WHO) show that more than 10 million people get ill from TB and 1.25 million die from the disease each year.1
Globally, TB is the number one killer of humans from a single infectious agent.
TB is present in all countries worldwide. However, geographically, most people who develop TB are in South-East Asia, Africa and the Western Pacific. In fact, nearly 20% of the people who are newly infected with TB disease live in the Western Pacific Region, of which Australia is a part.2 Five countries (Cambodia, China, Papua New Guinea, the Philippines and Vietnam) account for most new cases of the disease.2
The rate of new TB cases is continuing to increase in the Western Pacific.1 People who live in poverty or who are part of remote communities or marginalised groups are often the most affected.2 Symptoms can be mild for many months before getting worse, meaning that people with TB may spread the disease to others without knowing it.3
What is the impact of TB in Australia?
“In Australia we’re in a very fortunate position in that we have one of the lowest national TB incidence rates globally,” says Dr Chris Lowbridge, who leads the TB research program of the Menzies School of Health Research. The rate of new TB cases has remained stable in Australia, although the number of deaths caused by TB has increased.1 Latest WHO estimates show that, in 2023, 1600 people in Australia got sick from TB and 62 died from the disease.2
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TB is a disease of inequity that disproportionally affects people with lower socioeconomic status.
Dr Emma Smith
Most people with TB in Australia become infected in other, high-incidence countries. The Australian government has identified TB control in the Western Pacific region as critical to the elimination of TB in Australia.4 “However, there is still ongoing local transmission of TB occurring in Australia, particularly amongst First Nations Australians and remote communities,” says Dr Emma Smith, an infectious diseases physician and expert in TB care.
“TB is a disease of inequity that disproportionally affects people with lower socioeconomic status and crowded living arrangements,” says Dr Smith. The rate of TB is about four times higher in Aboriginal and Torres Strait Islander Australians than in non-Indigenous, Australian-born populations.4
What are the dangers of drug-resistant TB?
“We’ve made great progress in addressing TB in Australia,” says Dr Lowbridge. “However, TB is still a major public health challenge in the Southeast Asia and Western Pacific regions, which combined account for almost half of all drug-resistant TB cases globally.”
“Whereas for drug-sensitive TB, globally, we see treatment success in about 88% of people, latest available data show that treatment success for drug-resistant TB is much lower, at about 68%,” says Dr Lowbridge.1
The number of people diagnosed with drug-resistant TB increased by 60% over the last decade in the Western Pacific Region.2 In Australia, recent testing showed that 12% of people diagnosed with bacteriologically confirmed TB had drug-resistant disease and 2% had multidrug-resistant TB.4 Torres Strait Islander people are at particular risk of multidrug-resistant TB through a shared treaty zone with Papua New Guinea.4
How is drug-resistant TB currently managed?
Most cases of TB are drug-sensitive and treatable with standard first-line therapy consisting of the antibiotics isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rifampicin for 4 months. Drug-resistant TB is more difficult to treat, with different, longer treatment regimens that have more side effects, greater costs and lower survival rates.6
TB disease that is resistant to isoniazid but still sensitive to rifampicin is the most common form of drug-resistant TB and is associated with an increased risk of multidrug-resistant TB, defined as resistance to both isoniazid and rifampicin.5
For people with rifampicin-resistant TB or multidrug-resistant TB, WHO-recommended treatment includes a regimen consisting of the newer antibiotics bedaquiline and delamanid, plus linezolid, combined with levofloxacin or clofazimine.5 Treatment for drug-resistant TB is typically 6 months, but may take 9 months for patients with severe disease or a slow response to treatment, and up to 20 months if the disease is extensive.
Early diagnosis and treatment can help limit the spread of drug-resistant TB. Stewardship of bedaquiline and other new antibiotics is important to balance the availability of effective treatment against the increased risk of developing and spreading resistance that comes with higher usage.
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A big opportunity to improve management of drug-resistant TB is improving the way that TB programmes and governments support people with drug resistant TB.
Dr Chris Lowbridge
Challenges and opportunities
All 194 member states of the United Nations and the WHO have adopted the goal to end the global TB pandemic.1 Within Australia, eliminating local TB transmission is a particular focus.4
Emerging TB strains that are resistant to bedaquiline and other new TB medications pose a significant challenge to reaching the goal to end TB.8 The control of drug-resistant TB requires early detection and treatment as well as research and development of new antibiotics and other effective drugs.
Prices for antibiotics used to treat drug-resistant TB have come down this year, which will help more people to be treated globally.9 Set against this, cuts to foreign aid funding earlier this year are likely to significantly hamper progress for TB programmes, including for research.10,11
One of the main targets of the End TB Strategy is to lower the costs faced by people with TB and their households.1 Approximately 50% of people undergoing TB diagnosis and treatment face catastrophic costs that exceed one-fifth of their annual household income.1
“This rises to about 80% for drug-resistant TB,” says Dr Lowbridge. “Thus, almost all households that are affected by drug-resistant TB face significant economic impacts through the costs of accessing medical care, accessing treatment, and lost income during treatment and recovery.”
“A big opportunity to improve management of drug-resistant TB is improving the way that TB programmes and governments support people with drug resistant TB,” Dr Lowbridge explains. “This includes having better policies around universal health coverage, social protection and financial support.”
References
1. World Health Organization. Global tuberculosis report. 2024. Available at: https://www.who.int/publications/i/item/9789240101531.
2. Oh KH, Morishita F, Rahevar K, Yadav RP, Tran HTG, Marks GB, et al. The Western Pacific Regional Framework to End TB: overview and critical reflection. IJTLD Open. 2025;2(2):64-72.
3. Luies L, du Preez I. The echo of pulmonary tuberculosis: mechanisms of clinical symptoms and other disease-induced systemic complications. Clin Microbiol Rev. 2020;33(4).
4. Australian Government Department of Health and Aged Care. Communicable diseases intelligence: the strategic plan for control of tuberculosis in Australia, 2021–2025. Available at: https://doi.org/10.33321/cdi.2022.46.48.
5. World Health Organization. WHO operational handbook on tuberculosis. Module 4: treatment and care. Available at: https://www.who.int/publications/i/item/9789240108141. .
6. Shaw ES, Stoker NG, Potter JL, Claassen H, Leslie A, Tweed CD, et al. Bedaquiline: what might the future hold? Lancet Microbe. 2024;5(12):100909.
7. Australian Government Department of Health and Aged Care. Communicable diseases intelligence: Australian recommendations for the management of drug-resistant tuberculosis, 2023. Available at: https://doi.org/10.33321/cdi.2023.47.48.
8. Quansah N, Arriaga MB, Calderon RI, Shin S, Molldrem S, Niemann S, et al. Flying blind: urgency for drug – resistant testing for new tuberculosis drugs. Lancet Microbe. 2025;6(6):101106.
9. Holt E. Price reductions in drug-resistant tuberculosis treatments. Lancet Microbe. 2025:101168.
10. World Health Organization. Funding cuts impact access to TB services endangering millions of lives. 5 March 2025. Available at: https://www.who.int/news/item/05-03-2025-funding-cuts-to-tuberculosis-programmes-endanger-millions-of-lives.
11. Burki T. The fate of tuberculosis programmes without USAID. Lancet Microbe. 2025:101145.
Anja Becher is a Sydney-based freelance medical writer. She has more than 20 years’ experience writing across a wide range of health topics, including cardiovascular and respiratory medicine, metabolic diseases, gastroenterology and oncology.
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