Tuberculosis epidemiology and programmatic progress in the WHO Western Pacific Region, 2010-2024: an analysis of...

Tuberculosis (TB) remains a major public health challenge in the WHO Western Pacific Region, which accounts for over one quarter of the global TB burden. This study provides an updated regional assessment of TB epidemiology and programmatic performance to inform priority actions.

We conducted a retrospective descriptive analysis of estimated TB burden and country-reported surveillance and programme data from the WHO global TB database, examining trends in TB epidemiology and programme performance in the Western Pacific Region between 2010 and 2024 with emphasis on progress since 2015 in line with the End TB Strategy. Analyses were undertaken at regional and country levels across 37 countries and areas, covering TB burden, case notifications, diagnostics, drug-resistant TB, TB-HIV care, treatment outcomes, TB preventive treatment (TPT), and costs faced by TB-affected households.

In 2024, an estimated 2.9 million people developed TB in the Region, with 227,000 TB-related deaths. Since 2015, TB incidence has stagnated (1.6% increase) and mortality has declined only modestly (1.3%). Following COVID‑19‑related disruptions, TB case notifications rebounded to near pre-pandemic levels by 2022, reaching 2.2 million in 2024; however, treatment coverage remained suboptimal at 75%. TB cases were concentrated in a small number of countries, led by Indonesia, the Philippines, and China. TB epidemiology was heterogeneous: children accounted for > 20% of notifications in several Pacific countries, older adults ≥ 65 years for > 50% in low-incidence economies, and foreign-born individuals for a large share of cases in migrant-receiving countries. Diagnostic performance improved substantially, with use of WHO‑recommended rapid diagnostics increasing from 4.2% in 2015 to 70% in 2024, and bacteriological confirmation from 43 to 59%. Detection of multidrug- or rifampicin-resistant TB doubled over the past decade. TB-HIV co‑infection accounted for 2.2% of notified TB, with HIV status ascertained in 70%, and ART coverage remaining at 50-69%. Treatment success for new and relapse TB declined slightly to 86-87% in 2022-2023. TPT enrolment increased more than 14-fold since 2015, yet coverage of eligible contacts remained low at 7.4%.

Despite notable programmatic achievements in TB diagnosis, treatment and prevention, overall progress toward ending TB in the Western Pacific Region remains slow and uneven. Accelerating progress will require country-tailored strategies that respond to diverse epidemiological contexts and risk-group needs, alongside urgent action to close persistent case-detection and notification gaps, strengthen equitable TB care for vulnerable populations, and expand access to short‑course TPT.