As the world grapples with its goal to end tuberculosis (TB) by 2030, the disease remains a leading infectious killer worldwide, particularly affecting low- and middle-income countries. 

The World Health Organization (WHO) 2024 Global Tuberculosis Report issued at the end of October indicates both hopeful progress and daunting challenges in the fight against TB. 

Cambodia, a high-burden country, exemplifies the global struggle against TB, having made significant progress in reducing the incidence of the disease over the past two decades. However, it continues to face challenges that could hinder achieving the 2030 target.

Chuob Sok Chamroeun, executive director of the Khmer HIV/AIDS NGO Alliance (KHANA), said that in line with WHO’s vision of a "world free of TB", Cambodia has laid out its own strategic plan. 

Chamroeun noted that “the WHO's target is to reduce TB deaths by 90 per cent and TB incidence by 80 per cent compared to 2015 levels by 2030.”

He presented key facts, underscoring TB as the "top infectious killer globally" and stressing the need for consistent efforts in finding and treating all cases. 

He highlighted the airborne nature of the disease, stating that it can "affect anyone, anywhere". 

According to the WHO report, in 2023, an estimated 10.8 million people globally fell ill with TB, while the number of officially reported and diagnosed cases stood at 8.2 million. This marks a slight increase from previous years and a 15 per cent rise compared to pre-pandemic levels.

The incidence rate, or new cases per 100,000 people, increased only marginally by 0.2 per cent from 2022 to 2023, indicating a stabilisation in the number of new cases.

Dr. Tereza Kasaeva, director of the WHO Global Tuberculosis Programme, emphasised, “The global fight against TB requires unwavering commitment. Despite pandemic-related setbacks, we are witnessing strong recovery efforts that offer hope.”

TB incidence is most concentrated in 30 high-burden countries, which account for 87 per cent of global cases. Five countries – India, Indonesia, China, the Philippines and Pakistan – collectively account for over half of global cases. 

The WHO End TB Strategy, launched in 2015, set targets to reduce the incidence of TB by 50 per cent and TB-related deaths by 75 per cent by 2025, compared to 2015 levels.

However, global reductions have fallen short, with only an 8.3 per cent decline in incidence and a 23 per cent reduction in mortality by 2023.

Cambodia: A case of steady progress

Cambodia’s experience with TB reflects both the gains and setbacks that characterise the broader fight against the disease in Southeast Asia. 

In the early 2000s, the country’s TB incidence rate was over 500 cases per 100,000 people. 

Through aggressive programmes and international support, this figure has steadily declined, reaching 320 per 100,000 in 2022. 

The 2024 Global Tuberculosis Report highlights that Cambodia remains on the global TB watchlist, which focuses on countries needing continued attention for prevention and control.

The launch of an e-counselling initiative and comic book on the Tuberculosis programme at Sunway Hotel in Phnom Penh in May 2019. Post Staff

A key milestone for the country was the completion of its third national TB prevalence survey in July 2024, which aims to update incidence estimates, providing critical data that will inform TB control strategies and guide the country’s efforts to meet the WHO's targets. 

The final results are expected to be included in the 2025 TB report, informing policy adjustments alongside WHO’s broader observations. With global TB incidence showing only a minor rise in 2023, this suggests a trend towards stabilisation.

These reductions underscore the country’s success in expanding TB diagnostic services, improving access to treatment and implementing WHO’s Directly Observed Treatment, Short-Course (DOTS) strategy, which involves a health care worker observing a patient swallow their prescribed medication. 

The National Tuberculosis Programme (NTP) has been instrumental in combating TB, providing free treatment services and aiming to screen and treat high-risk populations, including people living with HIV. 

WHO director-general Dr. Tedros Adhanom Ghebreyesus highlighted the broader challenge, stating, “TB is the definitive disease of deprivation. Addressing TB means not only curing the disease but also tackling the social determinants that fuel its spread.”

However, Cambodia still faces numerous hurdles. One major challenge is ensuring continuous access to TB services in rural areas, where healthcare infrastructure is limited. 

Furthermore, as TB remains stigmatised in many communities, individuals may hesitate to seek timely diagnosis and treatment, increasing the likelihood of transmission. 

“A slight increase in incidence rates observed in recent years may reflect residual effects of Covid-19, as healthcare resources were stretched and disruptions impacted TB services,” according to the report. 

Regional comparison and goals

Regionally, Southeast Asia accounts for nearly 45 per cent of global TB cases, with high incidence rates across Cambodia, the Philippines and Indonesia. 

The WHO’s Southeast Asia region has experienced modest declines in incidence, but like Cambodia, other countries face obstacles that threaten progress. 

“Despite these challenges, the Southeast Asian region remains committed to the WHO’s End TB Strategy, which calls for significant reductions in TB incidence and mortality by 2025 as intermediate milestones toward eradication in 2030,” said the report. 

The WHO’s Western Pacific region, which includes Cambodia, has also faced setbacks in TB elimination due to the pandemic. 

The report said countries in this region are increasingly focusing on TB prevention, rapid diagnostics and treatment for drug-resistant TB. 

Funding and the road ahead

Achieving TB eradication by 2030 remains a tall order, given the financial and structural constraints faced globally. 

WHO’s targets include mobilising $22 billion annually by 2027 for TB services and another $5 billion annually for research. 

Currently, funding falls far short of these figures, with only $5.7 billion raised in 2023. 

Kasaeva noted, “A major barrier in the fight against TB is the lack of sufficient funding. We need a collective commitment to transform promises into resources and actions.”

Cambodia, dependent on international aid for TB services, requires sustained financial support to maintain its progress. 

The country’s success with DOTS offers hope for other high-burden countries; however, achieving the 2030 target requires accelerated efforts, substantial funding and enhanced social protection.

USAID Administrator Samantha Power commended the country for its achievements toward eliminating TB and malaria.

During an October 23 press conference in Phnom Penh, Power said that USAID’s focus is on TB elimination. 

“Cambodia is working toward the goal of eliminating TB by 2030, and USAID has pledged an additional $4 million to support local community-based efforts,” she said. 

Additionally, the development and distribution of a new TB vaccine, expected within the next five years, could be a game-changer. 

Until then, preventive measures, diagnostic improvements and ensuring access to medication remain top priorities.

The country’s progress in reducing TB incidence offers optimism, yet the road to 2030 is fraught with challenges. 

“In Cambodia, we have the National Centre for Tuberculosis and Leprosy Control [CENAT] playing a key role in ensuring that TB elimination goals are achieved,” said Chamroeun.

Global reductions in TB incidence and mortality are far from the WHO’s milestones, and while Cambodia has made commendable strides, a resurgence in cases could derail the gains. 

Dr. Kasaeva’s call for unity resonates strongly in this context: “Only through our collective determination can we end TB once and for all.”