WHO Urges People-Centred Solutions to End TB in High-Risk and Marginalized Groups

Tuberculosis (TB) continues to ravage millions around the world, despite being both preventable and curable. In 2023 alone, 10.8 million people fell ill with TB, and 1.25 million died from it, including 161,000 people living with HIV. The World Health Organization’s 2025 policy brief, developed by the Global Programme on Tuberculosis and Lung Health, shines a spotlight on the inequities at the heart of this public health crisis. The brief is the product of wide-ranging global collaboration, drawing on research and peer review from institutions such as the University of Toronto, Boston University, BRAC, University College London, York University, and the International Union Against Tuberculosis and Lung Disease. These partners emphasize that the persistence of TB reflects not only a medical failure but also a profound societal one, deeply rooted in poverty, marginalization, and unequal access to care.

Who Is Most at Risk, and Why?

TB does not affect everyone equally. While anyone can contract the disease, those living in poverty, working in unsafe or overcrowded environments, or facing systemic discrimination are significantly more vulnerable. The brief details how structural barriers, such as inadequate housing, weak health systems, poor nutrition, and legal exclusion, combine with health-related risk factors to drive the disease. Comorbidities like HIV, diabetes, substance use disorders, and mental illness further increase the risk of developing active TB. Undernutrition alone accounted for nearly one million TB cases in 2023, while smoking, alcohol use, and HIV infection also played major roles. The WHO presents a compelling framework showing how these biological, social, and demographic vulnerabilities overlap and multiply risk, particularly in high-burden countries.

Populations frequently named as high-risk include migrants, prisoners, Indigenous and First Nations Peoples, health workers, sex workers, people who inject drugs, the urban and rural poor, and sexual and gender minorities. For these groups, barriers to care are not just logistical but often legal or cultural. Discriminatory policies, stigma, and fear of arrest or deportation can deter individuals from seeking care, even when services are technically available. The risk is particularly acute in places like prisons, refugee camps, and urban slums, where people live in close quarters with limited sanitation and health infrastructure. The compounded effects of exclusion and disease make these communities especially difficult to reach without deliberate, equity-driven interventions.

From Data to Action: Identifying Those Left Behind

Understanding who is most vulnerable is critical to designing a response that leaves no one behind. The WHO encourages the use of diverse data sources, national surveillance systems, surveys, qualitative research, and digital tools to paint an accurate picture of TB risk. Tools like the PERISKOPE-TB risk predictor and Canada’s TB-MIGRATE platform are examples of innovations helping to estimate individual TB risk in various contexts. However, routine data collection often misses those who never make it into health facilities, including undocumented migrants and people in informal settlements. To address this, the policy brief urges countries to develop complementary data systems with strong safeguards for privacy and human rights.

A global survey conducted in 2023, with 153 responses from 73 countries, revealed that while many countries recognize the need to target high-risk populations, they often lack policies and systems robust enough to act on this knowledge. This gap in strategic response perpetuates cycles of late diagnosis, ineffective treatment, and high transmission rates, especially in communities already disadvantaged by poverty, discrimination, or conflict.

People-Centred Solutions for Prevention and Care

The WHO proposes a comprehensive set of interventions tailored for vulnerable populations. These include systematic screening using rapid molecular diagnostics, chest X-rays with AI-assisted interpretation, Bacille Calmette-Guérin (BCG) vaccination, and tuberculosis preventive treatment (TPT). Special emphasis is placed on community-based services that bring care closer to those who need it most. Peer counselling, digital adherence tools, and decentralized clinics can help ensure that people complete treatment and receive social support along the way.

Children, adolescents, people living with HIV, and others at high risk must be prioritized in prevention efforts. For example, household contacts of TB patients and people with fibrotic lesions or immunosuppressive conditions are prime candidates for preventive care. The brief also highlights successful examples of active case-finding among incarcerated women in Peru, tribal populations in India, and transgender women in Pakistan, showing that localized, culturally-sensitive interventions work when communities are engaged as partners rather than passive recipients of care.

Beyond Medicine: Tackling the Root Causes

TB cannot be eradicated through medical interventions alone. The WHO insists that addressing the disease requires tackling its root causes: poverty, hunger, poor housing, legal discrimination, and unequal access to health systems. Multisectoral collaboration is essential. Ministries of health must work alongside those responsible for housing, labour, social protection, and refugee services. Policy changes, such as updating discriminatory laws, expanding social protection schemes, and investing in education, are needed to dismantle the structural barriers that keep people trapped in cycles of illness and exclusion.

Importantly, the brief underscores the necessity of meaningful community engagement. Affected populations must have a voice in shaping the policies and services that affect them. Innovations like video-supported treatment and point-of-care diagnostics have a role to play, but only if integrated into a rights-based, people-centred approach that recognizes the dignity and agency of every person affected by TB.

Ending TB is more than a medical mission; it is a matter of justice. The disease thrives where rights are denied, resources are scarce, and systems fail. By placing the most vulnerable at the heart of global TB efforts, the WHO argues, we can not only control the disease but take a decisive step toward a healthier and more equitable world.