While science advances toward shorter treatment regimens, new vaccines, and more effective clinical strategies, eliminating the disease will remain elusive without addressing inequalities and social determinants.
This discussion, led by the WHO (World Health Organization), was the central theme of the debates at the largest global congress on lung health and tuberculosis, organized by The Union (International Union against Tuberculosis and Lung Disease), which took place in Copenhagen (Denmark).
Tuberculosis remains the leading cause of death from a single infectious agent worldwide. In 2024, 10.7 million people fell ill and 1.23 million died from the disease, according to the WHO. In Brazil, 85,936 new cases were recorded, with more than 6,000 deaths.
According to the researchers, it is essential that there is a change in the way of dealing with the disease, strengthening the role of social policies in adherence to treatment and in reducing cases.
“It is not only the side effects of the drug that lead to abandonment. People interrupt treatment because they have nothing to eat or money to pay for transport to the health unit,” explains Brazilian researcher Melisane Lima, specialist in social protection associated with the fight against tuberculosis and who presented a paper at the congress.
Abandonment, in addition to compromising individual recovery, maintains active transmission and promotes the emergence of resistant strains. As part of this research, Melisane developed and validated a matrix of social protection indicators for people with tuberculosis in Brazil.
The instrument assesses whether patients can access rights related to health, social assistance and pensions, in addition to the articulation between public policies. The proposal has already been cited in ILO (International Labor Organization) reports and WHO guides.
According to the researcher, the tool can be used by managers and civil society to guide public policies. “This makes it possible to plan, monitor and evaluate actions, while respecting the differences between municipalities and countries,” he says.
In Brazil, experiences are still uneven, but certain initiatives are gaining importance. One example is Rio de Janeiro, which implemented a food card project for people undergoing treatment for tuberculosis.
This allowance, currently around R$430 per month, allows the purchase of food and has already shown positive preliminary results in reducing dropouts. Since September, 7,459 people have been registered and currently 3,231 patients are receiving assistance.
In addition to TB-specific policies, broader cash transfer programs also show impact. Studies indicate that Bolsa Família helps increase treatment adherence and reduce deaths from tuberculosis.
Another relevant instrument is the Continuous Payment Benefit (CPB). “These are policies sensitive to tuberculosis, even if they do not have the disease as a direct criterion,” explains Mélisane.
However, many of these rights are unknown to patients themselves. Social benefits, free transport and housing policies are part of a little-discussed legal framework in the health sector. This invisibility weighs even more heavily on vulnerable groups, such as the homeless, people deprived of their liberty, people living with HIV and immigrants.
Stigma also remains an obstacle. “Many people think that tuberculosis no longer exists or that there is no cure,” explains Mélisane. “But to get tuberculosis, you just have to breathe.”
It is at this intersection between biomedical innovation and social policy that Rio de Janeiro has structured its response to the disease, according to municipal Health Secretary Daniel Soranz. He says the strategy combines technology, primary care and intersectoral actions.
One of the axes is an electronic system that transforms the notification form into an integrated online medical record. “It will be filled over time, by several units,” he explains. The tool makes it possible to monitor examinations, discontinuation of medications and to identify early the risks of abandonment and failure in contact tracing.
The indicators reflect operational improvement. The proportion of new laboratory-confirmed cases increased by 2.3% between 2023 and 2024 and by 32.6% since 2012. HIV testing among new cases reached 95.5% in 2024. The proportion of contacts screened increased by 4.2% last year.
Another central subject is that of people deprived of their liberty. The city of Rio de Janeiro took over primary care in prisons in the capital Rio de Janeiro, monitoring approximately 30,000 inmates. “One in ten cases of tuberculosis in the state comes from the prison system,” Soranz says.
Thanks to the work of family health teams in the units, there has been an increase in diagnosis and cure rates, in addition to better control of retreatments.
The most recent data indicate a gradual decline in the incidence of the disease in the city: from 7,024 cases in 2022 to 6,774 in 2024. Soranz nevertheless recognizes the limits of exclusively biomedical progress. “There’s no point investing only in new diagnostic technologies if you don’t take into account social determinants,” he says. “Without fighting poverty, hunger and exclusion, progress cannot be sustainable.”
At the Copenhagen congress, a global analysis was released showing how countries are disproportionately affected by tuberculosis. The disease reporting rate ranges from 25 per 100,000 population in high-income countries to 150 per 100,000 in middle- and low-income countries.
In the view of Kobto Koura, director of tuberculosis at the Union, the findings show that greater equity is needed for low- and middle-income countries to invest in approaches that integrate evidence-based interventions (such as active case finding), strengthen health systems and address the social determinants that lead to disease transmission and progression.
“These include combating poverty, improving nutrition, reducing tobacco and alcohol abuse, controlling comorbidities such as HIV and diabetes, and improving public health education.”
According to the WHO Global Tuberculosis Report 2025, 89% of people who developed tuberculosis in Brazil were officially diagnosed and notified. Among countries with a high disease burden, the country leads the service coverage index, reaching more than 80%. This index measures access and quality of health services based on 14 parameters, including coverage of tuberculosis treatment.
The Public Health project benefits from the support of Umane, a civil association which aims to support initiatives aimed at promoting health.
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