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Monitoring progress towards the targets of the new Tuberculosis Action Plan for the WHO European Region 2023–2030 is challenging due to limited or no reporting on some indicators. Only 20 out of 30 indicators described in the Action Plan were monitored and evaluated using routine surveillance data.

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There is a clear need for all countries in the Region, including those in the EU/EEA, to focus on improving data, making data more representative and complete, and using different sources to complement existing surveillance information.

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According to ECDC Director Dr Andrea Ammon, “In the aftermath of the COVID-19 pandemic, we still have a long road ahead of us for meeting the TB elimination targets. Timely strengthening of prevention, testing and treatment are key elements in fighting TB, and any delays are translated into further suffering and death. Countries must act now, and ECDC remains committed to partnering with and supporting European Union/European Economic Area (EU/EEA) countries in their efforts to end the TB epidemic.”

Worryingly, on average only 6 out of 10 TB treatments using first-line medicines were successful in curing the infection in the EU/EEA countries. In the Region overall, 7 out of 10 TB treatments cured the infection. These are the lowest rates in a decade, indicating possible issues with treatment compliance and likely gaps in monitoring of treatment outcomes. If properly planned and carried out, TB treatment should be successful in roughly 9 out of 10 patients infected with strains that respond to the antibiotics rifampicin and isoniazid.

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Nearly 7000 excess deaths from tuberculosis (TB) occurred in the WHO European Region in the 3 years of the COVID-19 pandemic (2020–2022) compared to what experts had expected based on pre-2020 estimates. This increased mortality was a direct result of the pandemic – it would not have occurred if TB diagnosis and treatment efforts had not been disrupted.

These increased numbers are likely to be a positive indication that, in many countries, TB services are now recovering from the disruptions of the COVID-19 pandemic and more people are being diagnosed and treated. They also likely reflect that the Region is catching up on delayed diagnoses.

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In 2022 HIV prevalence in incident TB cases was estimated to be 12%, with an estimated 28 000 cases of coinfection in the Region. In the EU/EEA, 13 436 TB cases had known HIV status, almost 4% of which were reported as HIV-positive. Available data show that 1 in 5 people with HIV/TB coinfection in the Region was not receiving antiretroviral therapy (ART) at all.

“The report also reveals another evolving, preventable tragedy: the prevalence of drug-resistant TB continues to rise. We urge national authorities to strengthen TB testing programmes, diagnose promptly and apply the latest WHO guidelines,” he added.

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Reported data show increased numbers of diagnoses in 2022 compared to the previous year. In 2022, 38 out of the 53 WHO European Member States reported increased TB notifications. The overall total number reached more than 170 000 cases (from over 166 000 cases in 2021), out of which more than 36 000 cases were reported in the EU/EEA (from over 33 500 in 2021).

Also of concern are signs that the management of TB and HIV coinfection is suboptimal. Only 48% of patients with both TB and HIV in the Region and 54% in the EU/EEA who started TB treatment in 2021 had been cured.

However, the picture is far from complete; only 20 countries provided information on the uptake of ART for HIV among TB patients, and only 3 of these were in the EU/EEA. Continued efforts are needed to improve the reporting of HIV coinfection.

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“Our latest report reveals a heartbreaking, entirely preventable situation: people affected by TB were not protected during the pandemic and 7000 needlessly lost their lives because of disruptions to TB services,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

This sobering revelation comes via the latest TB surveillance and monitoring report from WHO/Europe and the European Centre for Disease Prevention and Control (ECDC). The report highlights the most recent data, showing a region recovering from, but still experiencing, the impact of the pandemic on TB testing, diagnosis and care.