Tuberculosis

Our goal
To accelerate the global decline in tuberculosis incidence.
Better vaccines, drugs, and diagnostics are needed to reduce the burden of TB, which remains one of the leading causes of death worldwide.
Better vaccines, drugs, and diagnostics are needed to reduce the burden of TB, which remains one of the leading causes of death worldwide.

At a glance

  • Tuberculosis (TB) remains a leading cause of death from infectious disease worldwide, with an estimated 10 million new cases in 2019.
  • Current approaches to preventing, diagnosing, and treating TB are inadequate. Drug-resistant strains of TB have also emerged, creating a growing sense of urgency to control the spread of the disease.
  • We are working to better understand the basic science behind the TB epidemic and to support the development of new tools for prevention, diagnosis, and treatment as well as optimal delivery of TB care.
  • Our partners in combating TB include donor governments, multinational institutions, the pharmaceutical and biotechnology industries, and governments.
Our strategy

Our strategy

The foundation’s Tuberculosis team aims to address key gaps along the TB care pathway through new approaches to protecting against infection, preventing progression from infection to disease, and improving diagnosis and treatment. Our efforts are diversified based on the understanding that vaccines, diagnostics, drugs, and improved care delivery are all essential to addressing the TB epidemic.

Comparing old (left) and new (right) medicine regimens for tuberculosis at a hospital in Zhejiang Province.
Comparing old (left) and new (right) medicine regimens for TB at a hospital in Zhejiang Province, China.
Areas of focus

Areas of focus

We work in three strategic areas to accelerate progress toward TB eradication.

Our efforts to develop a treatment regimen that is safer, shorter, simpler, and more affordable began with the TB Drug Accelerator (TBDA) program, a partnership that aims to identify new drugs that work differently than existing drugs to kill TB bacteria.

Of the estimated 10 million new cases of TB worldwide each year, 3 million go undiagnosed and/or unreported. We are developing less expensive, more effective diagnostic tools that can reach more people who are infected with TB.

Bacille Calmette-Guérin (BCG), the only available TB vaccine, was developed almost 100 years ago and has limited efficacy after childhood. A more effective option is needed to prevent TB.

In India and China, we work with governments and other partners—including the World Health Organization (WHO), USAID, and the World Bank—to pilot innovative approaches to modernizing TB control.

We advocate for greater political commitment and funding to fight TB, particularly for research and development that can lead to new tools.

Why focus on tuberculosis?

Why focus on TB?

Over the past two decades, the world has made significant progress in the fight against TB. Between 2000 and 2019, TB mortality fell by 45 percent, and an estimated 63 million lives were saved thanks to coordinated global efforts and the use of the recommended treatment, the directly observed therapy short-course (DOTS) strategy.

While effective diagnosis and treatment have saved millions of lives, TB remains the leading cause of death from infectious disease worldwide. In 2019, an estimated 10 million people had newly developed TB, and nearly 1.4 million people died from the disease.

In recent years, drug-resistant strains of TB have created a growing sense of urgency to control the spread of the disease: MDR-TB, which is resistant to first-line drugs, and XDR-TB, which is also resistant to some second-line drugs. MDR-TB has appeared in nearly every country, with an estimated 465,000 new cases in 2019. These forms of the disease are difficult and costly to treat. The TB epidemic has also accelerated in concert with HIV: In 2019, about 208,000 people with HIV died of TB.

Current approaches to preventing, diagnosing, and treating TB are inadequate. The BCG vaccine protects young children against severe forms of TB but offers limited protection against pulmonary TB in adults, which is the most common form of the disease. The most widely used diagnostic method, microscopic detection of bacteria from sputum, identifies only half of all cases. It also requires special skills and is labor-intensive. Standard treatment regimens also have significant side effects. Many patients are unable to stay on treatment long enough to be cured.

As a result of these issues, current TB care and treatment programs identify, diagnose, and successfully treat only about 71 percent of all patients with active TB disease. While this represents a significant improvement, nearly 3 million cases remain unidentified each year.

Over the past decade, innovative new tools and delivery strategies have reduced deaths from TB and improved the quality of patient care. But more investments and greater collaboration are urgently needed to accelerate progress in treatment delivery and expand the pipeline of safe and effective drug and vaccine candidates.

A researcher in the microscopy room at the Lala Ram Swarup Institute of Tuberculosis and Respiratory Diseases in New Delhi, India.
A researcher in the microscopy room at the Lala Ram Swarup Institute of Tuberculosis and Respiratory Diseases in Delhi, India.

A more effective vaccine would be the single most powerful tool to reduce the incidence of TB. Even a partially effective new vaccine, if introduced in 2024, could decrease TB incidence by up to 70 percent by 2050, according to some projections.

As efforts to develop a better vaccine continue, newer tools are needed to interrupt the TB epidemic in the short and medium term. Improved diagnostic tools would reduce delays in starting treatment. A simpler, safer, shorter, and more affordable drug regimen would improve treatment success rates. New ways to use existing tools in order to identify patients early, link them to care, and facilitate faster and more effective treatment would help reduce the burden of TB.

The field of TB also needs more funding. The drugs and diagnostics currently in clinical development can reach the people who need them most only if they are affordable and can be deployed efficiently. Substantial funding is needed for research and development, and investments from developed and TB-endemic countries, pharmaceutical companies, and foundations must be sustained.

Program resources

Program resources

Strategy leadership

Strategy leadership

Nina Russell
Nina Russell
Director, TB & HIV Research and Development
Dr. Nina Russell oversees the foundation’s investments in vaccine and drug development to prevent and treat tuberculosis (TB) and HIV.
Gates Foundation placeholder image for leadership.
Yogan Pillay
Director, HIV & TB Delivery
Yogan Pillay leads the foundation’s efforts to strengthen TB & HIV Program Delivery globally.
Pervin Anklesaria
Pervin Anklesaria
Deputy Director, HIV and Tuberculosis
Pervin Anklesaria leads the HIV vaccines and biologics prevention efforts for the foundation’s HIV team.
Our partners

Our partners

We do our work in collaboration our partners, who join with us in taking risks, pushing for new solutions, and harnessing the transformative power of science and technology. The following is a selected list of our many partners.
Global Fund to Fight AIDS, Tuberculosis and Malaria

We partner with The Global Fund, which aims to accelerate the end of the AIDS, TB, and malaria epidemics. It mobilizes and invests more than US$4 billion a year to support programs run by local experts in more than 100 countries.

Stop TB Partnership

We support the Stop TB Partnership, an international network of more than 1,700 partners working to eliminate TB as a public health problem and ultimately achieve a world free of TB.

TB Alliance

We support the TB Alliance, a not-for-profit organization dedicated to accelerating the discovery and development of affordable new TB drugs.

World Health Organization (WHO)

WHO is a specialized agency of the United Nations whose primary role is to direct international health within the United Nations system and to lead partners in global health responses. The WHO Global TB Programme coordinates WHO’s global efforts to end TB.

Foundation for Innovative New Diagnostics (FIND)

We support FIND, a global nonprofit that advances the development and delivery of diagnostics to combat major diseases affecting the world’s poorest populations. FIND is working to develop easy-to-use, rapid, and reliable TB diagnostic tests and speed up access to new and existing tools.

TuBerculosis Vaccine Initiative (TBVI)

We support TBVI, a research and innovation partnership that works to advance research and development leading to new TB vaccines that are safe, effective, accessible, and affordable for all people.