Anyone can get sick with TB, as it is caused by bacteria that spreads in the air and mainly invades the lungs. (Photo: Silvio Ross/Pixabay)News & Features
12th November 2025 | Marcus Low
Around 54 000 people died of TB in South Africa in 2024 and 249 000 fell ill with the disease, according to new estimates from the World Health Organization (WHO).
Around 54 000 people died of TB in South Africa in 2024, according to figures released on Wednesday alongside the WHO’s latest World TB Report. This continues a slow downward trend in TB deaths in recent years.
Two decades ago, at the peak of the HIV epidemic, TB claimed in the region of 200 000 lives per year. The two epidemics are closely linked since uncontrolled HIV dramatically increases the risk that someone would develop TB disease. Accordingly, the growth of South Africa’s HIV treatment programme has gone hand-in-hand with reductions in TB. Of the 54 000 TB deaths in 2024, 29 000 were in people with HIV and 25 000 in people who were HIV negative.
The number of people falling ill with TB in the country is also declining. According to the new figures, 249 000 people fell ill with TB in 2024, compared to 270 000 in 2023 and 292 000 in 2022. Here too, recent numbers are much lower than two decades ago when this number was often above 600 000.
A persistent problem is that not everyone with TB disease is getting treatment. Around 184 000 people were diagnosed with TB in South Africa in 2024 – 74% of the 249 000 who fell ill. In other words, an estimated 65 000 people who fell ill with TB disease in the country last year were not diagnosed and accordingly did not receive treatment.
In an attempt to diagnose more people with TB more quickly, government has set an ambitious target of doing five million TB tests from April 2025 to March 2026. According to data obtained by Spotlight and GroundUp through a request in terms of the Protection of Access to Information Act, around 1.75 million tests were done in the six months from April to September. This suggests government is not on track to meet the five million target. Even so, it seems likely that more TB tests will be done this year than in any other year in the last decade.
As in previous years, the WHO has published relatively wide confidence intervals with several of their key estimates. For example, the actual number of people falling ill with TB is estimated to lie in the range 155 000 to 365 000. Such wide confidence intervals suggest there is significant uncertainty about the estimates.
The WHO’s estimates however generally fall in broadly the same ballpark as estimates from Thembisa, the leading mathematical model of TB in South Africa. According to the most recent Thembisa estimates, published in 2024, there were around 62 000 TB deaths in adults from mid-2023 to mid-2024 – slightly higher than the WHO’s estimate and excluding children. New estimates from the Thembisa model are expected soon.
Both the WHO and Thembisa’s estimates of TB deaths are much higher than Statistics South Africa’s report of around 20 000 TB deaths in 2022 (the most recent year for which we have StatsSA figures). While this may seem like a large discrepancy, there is a good explanation for the difference. StatsSA’s figures are typically a count of causes written on death certificates and there is compelling evidence that HIV and TB are dramatically underreported on death certificates. By contrast to StatsSA’s counts, both the WHO and Thembisa figures are modelled estimates that draw on multiple data sources to triangulate an estimate of the actual number of deaths.
The global picture
Globally, there was an estimated 1.23 million TB deaths in 2024, making TB the leading cause of death from a single infectious agent. Around 10.7 million people fell ill with TB, of which 8.3 million were diagnosed.
The epicentre of the global TB epidemic remains India. The country had 25% of all TB cases in 2024, followed by Indonesia with 10%, the Philippines with 6.8%, China with 6.5%, and Pakistan with 6.3%. In absolute terms, all these countries have substantially larger TB epidemics than South Africa.
When taken as TB cases per 100 000 people, South Africa’s 389 per 100 000 is however higher than rates in any of the five countries mentioned above apart from the Philippines. South Africa ranks 12th highest of all countries in terms of cases per 100 000 people.
Not surprisingly, South Africa remains on both the WHO’s list of countries with high TB burdens and its list of countries with a high burden of drug-resistant TB. There was an estimated 14 000 cases of drug-resistant TB in the country in 2024.
Impact of aid cuts
The WHO’s new report deals mainly with 2024, and thus largely precedes the abrupt cuts to health-related aid and research from the United States in 2025.
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But even prior to this year’s cuts, the WHO and others were already raising red flags about TB funding. “Funding for the TB response remains grossly inadequate and has been stagnating”, according to the new WHO report.
“Funding for provision of TB prevention, diagnosis and treatment amounted to US$ 5.9 billion in 2024, and funding for TB research was US$ 1.2 billion in 2023. These figures are 27% and 24%, respectively, of the global targets of US$ 22 billion and US$ 5 billion annually by 2027,” states the WHO Report.
“Cuts to funding from 2025 onward pose a serious challenge,” said Dr Tereza Kasaeva, Director of the WHO’s Department for HIV, TB, Hepatitis and STIs, in a WHO statement. “Modelling studies have already warned that long-term cuts to international donor funding could result in up to 2 million additional deaths and 10 million people falling ill with TB between 2025 and 2035. Even short-term disruptions to funding could lead to hundreds of thousands of excess deaths. It is vital that countries step up domestic resource allocation alongside international funding,” she said.
Note: You can find the full WHO World TB Report here, the South Africa country profile is here, and more detailed datasets, such as those used to generate the graph in this article, can be downloaded here.
