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GLOBAL TUBERCULOSIS REPORT 2012 v
Acknowledgements
This report on global tuberculosis care and control was produced by a core team of 13 people: Hannah Monica Dias,
Dennis Falzon, Christopher Fitzpatrick, Katherine Floyd, Philippe Glaziou, Tom Hiatt, Christian Lienhardt, Linh Nguy-
en, Charalambos Sismanidis, Hazim Timimi, Mukund Uplekar, Wayne van Gemert and Matteo Zignol. The team was
led by Katherine Floyd. Overall guidance was provided by the Director of the Stop TB Department, Mario Raviglione.
The data collection forms (long and short versions) were developed by Philippe Glaziou and Hazim Timimi, with
input from staff throughout the Stop TB Department. Hazim Timimi led and organized all aspects of data management.
Christopher Fitzpatrick, Inés Garcia and Andrea Pantoja conducted all review and follow-up of fi nancial data. The
review and follow-up of all other data was done by a team of reviewers that included Annabel Baddeley, Annemieke
Brands, Hannah Monica Dias, Dennis Falzon, Linh Nguyen, Hazim Timimi, Wayne van Gemert and Matteo Zignol in
WHO headquarters, Tom Hiatt in the Western Pacifi c Regional Offi ce, and Suman Jain, Sai Pothapregada and Moham-
med Yassin from the Global Fund. Data for the European Region were collected and validated jointly by the WHO
Regional Offi ce for Europe and the European Centre for Disease Prevention and Control (ECDC), an agency of the
European Union based in Stockholm, Sweden.
Philippe Glaziou and Charalambos Sismanidis analysed surveillance and epidemiological data and prepared the
fi gures and tables on these topics, with assistance from Tom Hiatt. Tom Hiatt, Linh Nguyen and Annabel Baddeley
analysed TB/HIV data and prepared the associated fi gures and tables. Dennis Falzon and Matteo Zignol analysed data
and prepared the fi gures and tables related to drug-resistant TB, with assistance from Shu-Hua Wang. Christopher
Fitzpatrick analysed fi nancial data, and prepared the associated fi gures and tables. Tom Hiatt and Wayne van Gemert
prepared fi gures and tables on laboratory strengthening and the roll-out of new diagnostics. Christian Lienhardt and
Karin Weyer prepared the fi gures on the pipelines for new TB drugs, diagnostics and vaccines, with input from the
respective Working Groups of the Stop TB Partnership. Tom Hiatt checked and fi nalized all fi gures and tables in an
appropriate format, ensuring that they were ready for layout and design according to schedule, and was the focal point
for communications with the graphic designer.
The writing of the main part of the report was led by Katherine Floyd, with contributions from the following people:
Philippe Glaziou, Charalambos Sismanidis and Jinkou Zhao (Chapter 2); Hannah Monica Dias, Haileyesus Getahun,
Thomas Joseph and Mukund Uplekar (Chapter 3); Christopher Fitzpatrick and Christian Gunneberg (Chapter 5); and
Annabel Baddeley, Haileyesus Getahun and Linh Nguyen (Chapter 7). Chapter 4, on drug-resistant TB, was prepared
by Dennis Falzon and Matteo Zignol, with input from Katherine Floyd, Philippe Glaziou, Ernesto Jaramillo and Chara-
lambos Sismanidis. Chapter 6, on diagnostics and laboratory strengthening, was prepared by Wayne van Gemert, with
input from Christopher Gilpin, Fuad Mirzayev and Karin Weyer. Chapter 8, on research and development, was written
by Christian Lienhardt, Karin Weyer and Katherine Floyd, with input and careful review by the chairs and secretariats
of the Working Groups of the Stop TB Partnership: particular thanks are due to Michael Brennan, Uli Fruth and Jenni-
fer Woolley (new vaccines); Daniella Cirillo, Philippe Jacon and Alessandra Varga (new diagnostics); and Cherise Scott
and Mel Spigelman (new TB drugs). Karen Ciceri edited the entire report.
Annex 1, which explains methods used to produce estimates of the burden of disease caused by TB, was written
by Philippe Glaziou, Katherine Floyd and Charalambos Sismanidis; we thank Colin Mathers of WHO’s Mortality and
Burden of Disease team for his careful review and helpful suggestions. The country profi les that appear in Annex 2 and
the regional profi les that appear in Annex 3 were prepared by Hazim Timimi. Annex 4, which contains a wealth of
global, regional and country-specifi c data from the global TB database, was prepared by Tom Hiatt and Hazim Timimi.
We thank Pamela Baillie in the Stop TB Department’s TB monitoring and evaluation team for impeccable admin-
istrative support, Doris Ma Fat from WHO’s Mortality and Burden of Disease team for providing TB mortality data
extracted from the WHO Mortality Database, Michel Beusenberg, Kusha Davar, Chika Hyashi and Yves Souteyrand
of WHO’s HIV department for the close collaboration that facilitated joint review and validation of TB/HIV data, and
Diana Weil for reviewing and providing helpful comments on the entire report. We also thank Taavi Erkkola, Luisa
Frescura and Peter Ghys from UNAIDS for providing TB/HIV data collected as part of the joint reporting process on
Universal Access in the Health Sector and Global AIDS Response Progress and for following up TB/HIV-related data
1210.0020_P_001_272.indd v 03/10/12 21:52
vi GLOBAL TUBERCULOSIS REPORT 2012
queries with countries, and Peter Ghys and Karen Stanecki (UNAIDS) for providing epidemiological data that were
used to estimate HIV-associated TB mortality.
We thank Sue Hobbs for her excellent work on the design and layout of this report; her contribution, as in previous
years, is greatly appreciated.
The principal source of fi nancial support for WHO’s work on monitoring and evaluation of TB control is the United
States Agency for International Development (USAID), without which it would be impossible to produce this report
on global TB care and control. Data collection, validation, analysis, printing and dissemination were also supported
by funding from the governments of Japan and the Republic of Korea. We acknowledge with gratitude their support.
In addition to the core report team and those mentioned above, the report benefi ted from the input of many staff
working in WHO’s regional and country offi ces and hundreds of people working for national TB programmes or within
national surveillance systems who contributed to the reporting of data and to the review of report material prior to pub-
lication. These people are listed below, organized by WHO region. We thank them all for their invaluable contribution
and collaboration, without which this report could not have been produced.
Among the WHO staff listed below, we thank in particular Amal Bassili, Andrei Dadu, Tom Hiatt, Khurshid Alam
Hyder, Daniel Kibuga, Rafael López Olarte, André Ndongosieme, Wilfred Nkhoma, Nobuyuki Nishikiori, Angélica
Salomão, Ward Schrooten, Marithel Tesoro and Henriette Wembanyama for their major contribution to data collection,
validation and review.
WHO sta in regional and country o ces
WHO African Region
Esther Aceng, Harura Adamu, Boubacar Abdel Aziz, Inacio Alvarenga, Balde Amadou, Cornelia Atsyor, Ayodele
Awe, Sanni Babatunde, Nayé Bah, Marie Barouan, Abera Bekele, Norbert Bidounga, Françoise Bigirimana, Christine
Chakanyuka, Gaël Claquin, Peter Clement, Claudina Cruz, Olusoti Daniel, Noel Djemadji, Louisa Ganda, Boingotlo
Gasennelwe, Joseph Imoko, Michael Jose, Joël Kangangi, Nzuzi Katondi, Samson Kefas, Bah Keita, Daniel Kibuga,
Hillary Kipruto, Mwendaweli Maboshe, Leonard Mbam Mbam, Azmera Molla, Julie Mugabekazi, André Ndongosieme,
Denise Nkezimana, Nicolas Nkiere, Wilfred Nkhoma, Ghislaine Nkone, Ishmael Nyasulu, Laurence Nyiramasarabwe,
Samuel Ogiri, Sally Ohene, Amos Omoniyi, Chijioke Osakwe, Philips Patrobas, Angélica Salomão, Neema Simkoko,
Desta Tiruneh, Henriette Wembanyama, Assefash Zehaie.
WHO Region of the Americas
Roberto del Aguila, Monica Alonso, Arletta Anez, Miguel Aragón, Denise Arakaki, Adriana Bacelar, Eldonna Bois-
son, Gustavo Bretas, Luis Gerardo Castellanos, Maggie Clay, Rachel Eersel, Gerry Eijkemans, Marcos Espinal, Yitades
Gebre, Mirtha Del Granado, Mónica Guardo, Jorge Hadad, Rosalinda Hernández, Vidalia Lesmo, Rafael López, Tamara
Mancero, Wilmer Marquiño, Mario Martínez, Fatima Marinho, Humberto Montiel, Romeo Montoya, Roberto Mon-
toya, José Moya, Kam Mung, Soledad Pérez, Jean Rwangabwoba, Hans Salas, Roberto Salvatella, Thais dos Santos,
Ward Schrooten, Alfonso Tenorio, Enrique Vazquez, Jorge Victoria, Anna Volz, Victor Zamora.
WHO Eastern Mediterranean Region
Ali Akbar, Mohamed Abdel Aziz, Samiha Baghdadi, Amal Bassili, Najwa ElEmam, Sevil Huseynova, Rhida Jebeniani,
Wasiq Khan, Hamida Khattabi, Nuzhat Leiluma, Aayid Munim, Ali Reza Aloudel, Karam Shah, Ireneaus Sindani,
Bashir Suleiman, Rahim Taghizadeh, Martin Van Den Boom.
WHO European Region
Evgeny Belilovsky, Andreea Cassandra Butu, Silvu Ciobanu, Pierpaolo de Colombani, Andrei Dadu, Irina Danilova,
Masoud Dara, Alain Disu, Jamshid Gadoev, Gayane Ghukasyan, Ogtay Gozalov, Sayohat Hasanova, Saliya Karymbae-
va, Kristin Kremer, Mehmet Kontas, Nikoloz Nasidze, Dmitry Pashkevich, Robertas Petkevicius, Valiantsin Rusovich,
Javahir Suleymanova, Vadim Testov, Bogdana Shcherbak-Verlan, Melita Vujnovic.
WHO South-East Asia Region
Iyanthi Abeyewickreme, Mohammad Akhtar, Vikarunnesa Begum, Vineet Bhatia, Erwin Cooreman, Puneet Dewan,
Md Khurshid Alam Hyder, Navaratnasingam Janakan, Rim Kwang Il, Kim Son Il, Franky Loprang, Jorge Luna, Partha
Mandal, La Win Maung, Nigor Muzafarova, Ye Myint, Eva Nathanson, Patanjali Nayar, Rajesh Pandav, Razia Pendse,
Sri Prihatini, K Rezwan, Ray Serrano, Mukta Sharma, Aminath Shenalin, Achuthan Sreenivas, Chawalit Tantinimit-
kul, Kim Tong Hyok, Namgyel Wangchuk, Supriya Warusavithana, Sidharta Yuwono.
1210_0020_P_001_272.indd vi 08/10/12 10:55
GLOBAL TUBERCULOSIS REPORT 2012 vii
WHO Western Paci c Region
Shalala Ahmadova, Nino Dayanghirang, Cornelia Hennig, Tom Hiatt, Narantuya Jadambaa, Sung Hye Kim, Woo-Jin
Lew, Yuhong Liu, Giampaolo Mezzabotta, Nobuyuki Nishikiori, Khanh Pham, Fabio Scano, Jacques Sebert, Marithel
Tesoro, Xuejing Wang, Catharina van Weezenbeek, Rajendra-Prasad Yadav, Dongbao Yu.
National respondents who contributed to reporting and veri cation of data
via the online global data collection system
WHO African Region
Oumar Abdelhadi, Abdou-Salam Abderemane, Coulibaly Abdoul Karim, Jean Abena, Felix Afutu, Sofi ane Alihal-
assa, Arlindo Amaral, Géneviève Angue Nguema, Claudina Augusto da Cruz, Fantchè Awokou, Swasilanne Bandeira,
Adama Bangoura, Jorge Barreto, Frank Bonsu, Ballé Boubakar, Mahamat Bourhanadine, Miguel Camara, Ernest Cho-
lopray, Nkem Chukwueme, Amadou Cissé, Catherine Cooper, Isaias Dambe, Serge Diagbouga, Aicha Diakité, Awa
Diop, Themba Dlamini, S’celo Dlamini, Pierre-Marie Douzima, Said Egwaga, Juan Eyene, Mugabe Frank, Justin Fremi-
not, Ndayikengurukiye Fulgence, Michel Gasana, Evariste Gasana, Ntahizaniye Gérard, Sandile Ginindza, Martin
Gninafon, Nii Hanson-Nortey, Adama Jallow, Nathan Kapata, Aristide Komangoya-Nzonzo, Patrick Konwloh, Jac-
quemin Kouakou, Egidio Langa, Bernard Langat, Gape Machao, Llang Maama-Maime, Jocelyn Mahoumbou, Angelo
Makpenon, David Mametja, Farai Mavhunga, Frank Mba Bekolo, Adamou Moustapha, Youwaoga Moyenga, James
Mpunga, Clifford Munyandi, Lindiwe Mvusi, Anne Mwenye, Ronald Ncube, Thaddée Ndikumana, Biruck Negash,
Antoine Ngoulou, Emmanuel Nkiligi, M Nkou, Joshua Obasanya, Davidson Ogunade, Hermann Ongouo, Jean Okiata,
Maria Palma, Victor Pereira, Martin Rakotonjanahary, Sahondra Randriambeloson, Bakoliarisoa Ranivomahefa, Thato
Raleting, F Rujeedawa, Mohameden Salem, Charles Sandy, Marie Sarr-Diouf, Mineab Sebhatu, Mamie Shoma, Joseph
Sitienei, Nicholas Siziba, Dawda Sowe, Kassim Traore, Abdallahi Traoré, Alie Wurie, Assefash Zehaie, Abbas Zezai, Eric
Zoungrana
WHO Region of the Americas
Christian Acosta, Sarita Aguirre, Shalauddin Ahmed, Valentina Alarcón, Xochil Alemán, Valeria Almanza, Raúl Alva-
rez, Mirian Alvarez, Alister Antoine, Chris Archibald, Carlos Ayala, Wiedjaiprekash Balesar, Draurio Barreira, Patricia
Bartholomay, María Bermúdez, Jaime Bravo, Lynrod Brooks, Marta Calona, John Cann, Martín Castellanos, Jorge
Castillo, Kenneth Castro, Roxana Céspedes, Gemma Chery, Diana Claxton-Carty, Sonia Copeland, Clara Cruz, María
de Lourdes, Dy-Juan De Roza, Richard D’Meza, Roger Duncan, Mercedes España, Luis Fernando Fernandez, Hugo Fer-
nandez, Clara Freile, Victor Gallant, Julio Garay, Jennifer George, Izzy Gerstenbluth, Perry Gómez, Silvino González,
Lizbeth Guevara, Yaskara Halabi, Dorothea Hazel, Maria Henry, Josefi na Heredia, Tania Herrera, Martin Huirse, Alina
Jaime, Carla Jeffries, Kathryn Johnston, Ashok Kumar, Athelene Linton, María Llanes, Cecilia Lyons, Eugène Maduro,
Marvin Maldonado, Francisco Maldonado, Andrea Maldonado, Marvin Manzanero, Belkys Marcelino, Ada Martínez,
Celia Martínez de Cuellar, Zeidy Mata, Timothy McLaughlin-Munroe, Mary Mercedes, Jeetendra Mohanlall, Ernesto
Moreno, Alice Neymour, Persaud Nordai, Michael Owen, Gisele Pinto, Tomasa Portillo, Irad Potter, Bob Pratt, Edwin
Quinonez, Dottin Ramoutar, Anna Reyes, Leonarda Reyes, Paul Ricketts, Jorge Rodriguez, Adalberto Rodriguez, Maria
Rodriguez, Mirian Román, Katia Romero, Wilmer Salazar, Joan Simon, Manohar Singh, Sybil Smith, Jackurlyn Sutton,
Clarita Torres, Maribelle Tromp, Christopher Trujillo, William Turner, Melisa Valdez, Reina Valerio, Daniel Vazquez,
Nestor Vera, Juan Villeda, Asin Virginia, Eva de Weever, Michael Williams, Oritta Zachariah, Elsa Zerbini.
WHO Eastern Mediterranean Region
Salama AbouZeid, Naila Abuljadayel, Khaled Abu Rumman, Nadia Abu Sabra, Khadiga Adam, Shahnaz Ahmadi,
Amin Al-Absi, Samia Alagab, Abdulbary AlHammadi, Abdul Latif Al-Khal, Mohamed Al Lawati, Saeed Alsaffar, Fatma
Al Saidi, Kifah Alshaqeldi, Salah Ben Mansour, Kenza Bennani, Kinaz Cheikh, Walid Daoud, Mohamed Elfurjani,
Kamal Elneel, Rachid Fourati, Mohammed Gaafar, Amal Galal, Dhikrayet Gamara, Hawa Guessod, Dhafer Hashim,
Kalthoom Hassan, Basharat Javed, Hiba Kamal, Joseph Lasu, Syed Mahmoudi, Alaa Mokhtar, Alaa Mokhtar, Mahshid
Nasehi, Onwar Otien, Ejaz Qadeer, Mulham Saleh, Mohammad Seddiq, Khaled Sediq, Mohammed Sghiar, Mohemmed
Tabena, Hiam Yaacoub.
WHO European Region
Tleukhan Abildaev, Ibrahim Abubakar, Natavan Alikhanova, Avtandil Alisherov, Ekkehardt Altpeter, Laura Anderson,
Delphine Antoine, Gordana Radosavljevic Asic, Andrei Astrovko, Yana Besstraschnova, Oktam Bobokhojaev, Olivera
Bojovic, Bonita Brodhun, Claire Cameron, Noa Cedar, Daniel Chemtob, Domnica Chiotan, Ana Ciobanu, Nico Cioran,
1210_0020_P_001_272.indd vii 08/10/12 10:55
viii GLOBAL TUBERCULOSIS REPORT 2012
Andra Cirule, Thierry Comolet, Radmila Curcic, Manfred Danilovitš, Edita Davidavicene, Hayk Davtyan, Gerard de
Vries, Mladen Duronjuic, Connie Erkens, Jennifer Fernández, Viktor Gasimov, Lárus Guðmundsson, Walter Haas,
Hasan Hafi zi, Eugene Hanyukov, Armen Hayrapetyan, Peter Helbling, Gennady Hurevich, Jahongir Ismoilov, Mamuka
Japaridze, Jerker Jonsson, Maria Korzeniewska-Kosela, Aynura Koshoeva, Mitja Košnik, Gabor Kovacs, Rukije Mehm-
eti, Donika Mema, Vladimir Milanov, Seher Musaonbasioglu, Joan O’Donnell, Analita Pace-Asciak, Clara Palma, Elena
Pavlenko, Gilda Popescu, Bozidarka Rakocevic, Vija Riekstina, Jerome Robert, Elena Rodríguez-Valín, Kazimierz Rosz-
kowski, Petri Ruutu, Roland Salmon, Gerard Scheiden, Brian Smyth, Ivan Solovic, Petra Sorli, Stefan Talevski, Odo-
rina Tello-Anchuela, Mirzogolib Tilleashahov, Dilrabo Ulmasova, Gulnoz Uzakova, Piret Viiklepp, Pierre Weicherding,
Aysegul Yildirim, Maja Zakoska, Hasan Zutic.
WHO South-East Asia Region
Imesha Abeysekara, Aminath Aroosha, Si Thu Aung, Tashi Dendup, Nuruzzaman Haque, Emdadul Hoque, Suksont Jit-
timanee, Jang Yong Hui, Kashi Kant Jha, Badri Nath Jnawali, Niraj Kulshrestha, Ashok Kumar, Dyah Erti Mustikawati,
Costantino Lopes, Thandar Lwin, Chawetsan Namwat, Nirupa Pallewatte, Kiran Rade, Chewang Rinzin, Sudath Sama-
raweera, Yuwono Sidharta, Choe Kum Song, Asik Surya.
WHO Western Paci c Region
Paul Aia, Cecilia Arciaga, Christina Barry, Iobi Batio, Risa Bukbuk, Nou Chanly, Phonenaly Chittamany, Henry Daiwo,
Jiloris Dony, Jane Dowabobo, Saen Fanai, Rangiau Fariu, Ludovic Floury, Celina Garfi n, Shakti Gounder, Xaysangk-
hom Insisiengmay, Noel Itogo, Nese Conway, Mao Tan Eang, Mayleen Ekiek, Suzana Mohd Hashim, Chou Kuok Hei,
Cho En Hi, Nguyen Binh Hoa, Tom Jack, Seiya Kato, Pengiran Ismail, Daniel Lamar, Morisse Laurent, Wang Lixia, Liza
Lopez, Henri-Pierre Mallet, Khin Mar Kyi Win, Serafi Moa, Johana Ngiruchelbad, Batbayar Ochirbat, Connie Olikong,
Sosaia Penitani, Saia Penitani, Faimanifo Peseta, Nukutau Pokura, Waimanu Pulu, Marcelina Rabauliman, Bereka
Reiher, Bernard Rouchon, Temilo Seono, Cheng Shiming, Sang-sook Shin, Tokuaki Shobayashi, Tieng Sivanna, Grant
Storey, Dinh Ngoc Sy, Phannasinh Sylavanh, Kenneth Tabutoa, Markleen Tagaro, Cheuk-ming Tam, Wang Yee Tang,
Faafetai Teo-Yandall, Kyaw Thu, Kazuhiro Uchimura, Rosalind Vianzon, Du Xin, Dai Yoshizawa.
1210.0020_P_001_272.indd viii 03/10/12 21:52
GLOBAL TUBERCULOSIS REPORT 2012 1
Executive Summary
The World Health Organization (WHO) Global Tuberculosis
Report 2012 provides the latest information and analysis
about the tuberculosis (TB) epidemic and progress in TB
care and control at global, regional and country levels. It
is based primarily on data reported by WHO’s Member
States in annual rounds of global TB data collection. In
2012, 182 Member States and a total of 204 countries and
territories that collectively have more than 99% of the
world’s TB cases reported data.
Key  ndings
● Progress towards global targets for reductions in
TB cases and deaths continues. The Millennium
Development Goal (MDG) target to halt and reverse
the TB epidemic by 2015 has already been achieved.
New cases of TB have been falling for several years and
fell at a rate of 2.2% between 2010 and 2011. The TB
mortality rate has decreased 41% since 1990 and the
world is on track to achieve the global target of a 50%
reduction by 2015. Mortality and incidence rates are
also falling in all of WHO’s six regions and in most
of the 22 high-burden countries that account for over
80% of the world’s TB cases. At country level, Cam-
bodia demonstrates what can be achieved in a low-
income and high-burden country: new data show a
45% decrease in TB prevalence since 2002.
● However, the global burden of TB remains enor-
mous. In 2011, there were an estimated 8.7 million
new cases of TB (13% co-infected with HIV) and 1.4
million people died from TB, including almost one
million deaths among HIV-negative individuals and
430 000 among people who were HIV-positive. TB is
one of the top killers of women, with 300 000 deaths
among HIV-negative women and 200 000 deaths
among HIV-positive women in 2011. Global progress
also conceals regional variations: the African and
European regions are not on track to halve 1990 levels
of mortality by 2015.
● Access to TB care has expanded substantially
since the mid-1990s, when WHO launched a new glob-
al TB strategy and began systematically monitoring
progress. Between 1995 and 2011, 51 million people
were successfully treated for TB in countries that had
adopted the WHO strategy, saving 20 million lives.
● Progress in responding to multidrug-resistant
TB (MDR-TB) remains slow. While the number of
cases of MDR-TB notifi ed in the 27 high MDR-TB bur-
den countries is increasing and reached almost 60 000
worldwide in 2011, this is only one in fi ve (19%) of the
notifi ed TB patients estimated to have MDR-TB. In the
two countries with the largest number of cases, India
and China, the fi gure is less than one in ten; scale-up
is expected in these countries in the next three years.
● There has been further progress in implement-
ing collaborative TB/HIV activities (fi rst recom-
mended by WHO in 2004). These saved an estimated
1.3 million lives between 2005 and the end of 2011.
In 2011, 69% of TB patients were tested for HIV in the
African Region, up from 3% in 2004. Globally, 48% of
the TB patients known to be living with HIV in 2011
were started on antiretroviral therapy (ART); coverage
needs to double to meet WHO’s recommendation that
all TB patients living with HIV are promptly started on
ART. Kenya and Rwanda are top performers in HIV
testing and provision of ART.
● Innovations in diagnostics are being implement-
ed. The roll-out of Xpert MTB/RIF, a rapid molecular
test that can diagnose TB and rifampicin resistance
within 100 minutes, has been impressive. Between
its endorsement by WHO in December 2010 and the
end of June 2012, 1.1 million tests had been purchased
by 67 low- and middle-income countries; South Afri-
ca (37% of purchased tests) is the leading adopter. A
41% price reduction (from US$ 16.86 to US$ 9.98) in
August 2012 should accelerate uptake.
● The development of new drugs and new vaccines
is also progressing. New or re-purposed TB drugs
and novel TB regimens to treat drug-sensitive or drug-
resistant TB are advancing in clinical trials and regula-
tory review. Eleven vaccines to prevent TB are moving
through development stages.
● There are critical funding gaps for TB care and
control. Between 2013 and 2015 up to US$ 8 billion
per year is needed in low- and middle-income coun-
tries, with a funding gap of up to US$ 3 billion per
year. International donor funding is especially critical
to sustain recent gains and make further progress in
35 low-income countries (25 in Africa), where donors
provide more than 60% of current funding.
● There are also critical funding gaps for research
and development. US$ 2 billion per year is needed;
the funding gap was US$ 1.4 billion in 2010.
1210_0020_P_001_272.indd 1 08/10/12 10:56
2 GLOBAL TUBERCULOSIS REPORT 2012
Additional highlights by topic
Burden of disease
Geographically, the burden of TB is highest in Asia and
Africa. India and China together account for almost 40%
of the world’s TB cases. About 60% of cases are in the
South-East Asia and Western Pacifi c regions. The African
Region has 24% of the world’s cases, and the highest rates
of cases and deaths per capita.
Worldwide, 3.7% of new cases and 20% of previously
treated cases were estimated to have MDR-TB.
India, China, the Russian Federation and South Africa
have almost 60% of the world’s cases of MDR-TB. The
highest proportions of TB patients with MDR-TB are in
eastern Europe and central Asia.
Almost 80% of TB cases among people living with HIV
reside in Africa.
Est imating the burden of T B in chi ld ren (aged less than
15) is diffi cult; estimates are included in the report for the
fi rst time. There were an estimated 0.5 million cases and
64 000 deaths among children in 2011.
Case noti cations and treatment success
In 2011, 5.8 million newly diagnosed cases were notifi ed
to national TB control programmes (NTPs) and reported
to WHO, up from 3.4 million in 1995 but still only two-
thirds of the estimated total of 8.7 million people who fell
ill with TB in 2011.
Notifi cations of TB cases have stagnated in recent years.
New policy measures, including mandatory case notifi -
cation by all care providers via an electronic web-based
system in India, could have a global impact on the num-
ber of TB cases notifi ed in future years. Intensifi ed efforts
by NTPs to engage the full range of care providers using
public-private mix (PPM) initiatives are also important;
in most of the 21 countries that provided data, 10–40% of
notifi cations were from non-NTP care providers.
Globally, treatment success rates have been main-
tained at high levels for several years. In 2010 (the latest
year for which treatment outcome data are available), the
treatment success rate among all newly-diagnosed cases
was 85% and 87% among patients with smear-positive
pulmonary TB (the most infectious cases).
Responding to drug-resistant TB
Measurement of drug resistance has improved consider-
ably. Data are available for 135 countries worldwide (70%
of WHO’s 194 Member States) and by the end of 2012 will
be available from all 36 countries with a high burden of
TB or MDR-TB.
Extensively drug-resistant TB, or XDR-TB, has been
reported by 84 countries; the average proportion of MDR-
TB cases with XDR-TB is 9.0%.
The target treatment success rate of 75% or higher for
patients with MDR-TB was reached by only 30 of 107
countries that reported treatment outcomes.
Scaling up TB-HIV collaboration
Globally, 40% of TB patients had a documented HIV test
result and 79% of those living with HIV were provided
with co-trimoxazole preventive therapy in 2011.
Interventions to detect TB promptly and to prevent
TB among people living with HIV, that are usually the
responsibility of HIV programmes and general primary
health-care services, include regular screening for TB
and isoniazid preventive therapy (IPT) for those without
active TB. The number of people in HIV care who were
screened for TB increased 39% (2.3 million to 3.2 mil-
lion) between 2010 and 2011. Nearly half a million peo-
ple without active TB were provided with IPT, more than
double the number started in 2010 and mostly the result
of progress in South Africa.
Research and development to accelerate progress
Research to develop a point-of-care diagnostic test for TB
and MDR-TB continues, and other diagnostic tests are in
the pipeline.
Today, standard treatment for TB patients lasts six
months and the regimen for most patients with drug-
resistant TB takes 20 months. Treatment for MDR-TB is
costly and can have serious side-effects. Of the 11 anti-TB
drugs in clinical trials, two new drugs are being evaluated
to boost the effectiveness of MDR-TB regimens. A novel
regimen that could be used to treat both drug-sensitive
TB and MDR-TB and shorten treatment duration has
shown encouraging results in clinical trials.
There is no effective vaccine to prevent TB in adults.
Progress in the past decade means that it is possible that at
least one new vaccine could be licensed by 2020.
Financing for TB care and control
About US$ 1 billion per year of international donor fund-
ing is needed for TB care and control (excluding TB/HIV
interventions) in low and middle-income countries from
2013 to 2015, double existing levels. Up to an additional
US$ 1 billion per year is needed for TB/HIV interven-
tions, mostly for ART for HIV-positive TB patients.
National contributions provide the bulk of fi nancing
for TB care and control in Brazil, the Russian Federation,
India, China and South Africa (BRICS). However, they
remain insuffi cient for scaling up the diagnosis and treat-
ment of MDR-TB; BRICS account for about 60% of the
world’s estimated cases of MDR-TB.
The Global Fund provides almost 90% of international
donor funding for TB.
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GLOBAL TUBERCULOSIS REPORT 2012 3
CHAPTER 1
Introduction
Tuberculosis (TB) remains a major global health problem.
It causes ill-health among millions of people each year
and ranks as the second leading cause of death from an
infectious disease worldwide, after the human immuno-
defi ciency virus (HIV). The latest estimates included in
this report are that there were almost 9 million new cases
in 2011 and 1.4 million TB deaths (990 000 among HIV-
negative people and 430 000 HIV-associated TB deaths).
This is despite the availability of treatment that will cure
most cases of TB. Short-course regimens of fi rst-line
drugs that can cure around 90% of cases have been avail-
able since the 1980s.
The World Health Organization (WHO) declared TB a
global public health emergency in 1993. Starting in the
mid-1990s, efforts to improve TB care and control intensi-
fi ed at national and international levels. WHO developed
the DOTS strategy, a fi ve-component package compris-
ing political commitment, diagnosis using sputum smear
microscopy, a regular supply of fi rst-line anti-TB drugs,
short-course chemotherapy and a standard system for
recording and reporting the number of cases detected
by national TB control programmes (NTPs) and the out-
comes of treatment. Within a decade, almost all coun-
tries had adopted the strategy and there was considerable
progress towards global targets established for 2005: the
detection of 70% of the estimated number of smear-posi-
tive pulmonary cases (the most infectious cases) and the
successful treatment of 85% of these cases. In 2005, the
numbers of cases reported by NTPs grew to over 5 million
and treatment success rates reached 85%.
WHO’s currently-recommended approach to TB care
and control is the Stop TB Strategy, launched in 2006 (
Box
1.
2
). This strategy was linked to new global targets for
r
eductions in TB cases and deaths that were set for 2015
(
Box 1.3) as part of the Millennium Development Goals
(
MDGs) and by the Stop TB Partnership. The targets are
that TB incidence should be falling by 2015 (MDG Target
6.c) and that prevalence and death rates should be halved
compared with their levels in 1990.
The scale at which interventions included in the Stop
TB Strategy need to be implemented to achieve the
2015 targets for reductions in disease burden has been
described in Global Plans developed by the Stop TB Part-
nership. The latest plan covers the period 2011–2015 and
BOX 1.1
Basic facts about tuberculosis (TB)
TB is an infectious disease caused by the bacillus
Mycobacterium tuberculosis. It typically affects the
lungs (pulmonary TB) but can affect other sites as well
(extrapulmonary TB). The disease is spread in the air when
people who are sick with pulmonary TB expel bacteria, for
example by coughing. In general, a relatively small proportion
of people infected with Mycobacterium tuberculosis will
develop TB disease; however, the probability of developing
TB is much higher among people infected with the human
immunodefi ciency virus (HIV). TB is also more common
among men than women, and affects mostly adults in the
economically productive age groups.
Without treatment, mortality rates are high. In studies of the
natural history of the disease among sputum smear-positive
and HIV-negative cases of pulmonary TB, around 70% died
within 10 years; among culture-positive (but smear-negative)
cases, 20% died within 10 years.
1
The most common method for dia gnosing TB worldwide is
sputum smear microscopy (developed more than 100 years
ago), in which bacteria are observed in sputum samples
examined under a microscope. Following recent developments
in TB diagnostics, the use of rapid molecular tests for the
diagnosis of TB and drug-resistant TB is increasing, as high-
lighted in Chapter 6 of this report. In countries with more
d
eveloped laboratory capacity, cases of TB are also diagnosed
via culture methods (the current reference standard).
Treatment for new cases of drug-susceptible TB consists of a
6-month regimen of four fi rst-line drugs: isoniazid, rifampicin,
ethambutol and pyrazinamide. Treatment for multidrug-
resistant TB (MDR-TB), defi ned as resistance to isoniazid and
rifampicin (the two most powerful anti-TB drugs) is longer, and
requires more expensive and toxic drugs. For most patients
with MDR-TB, the current regimens recommended by WHO last
20 months.
1
Tiemersma EW et al. Natural history of tuberculosis: duration
and fatality of untreated pulmonary tuberculosis in HIV-negative
patients: A systematic review. PLoS ONE 2011 6(4): e17601.
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4 GLOBAL TUBERCULOSIS REPORT 2012
BOX 1.2
The Stop TB Strategy at a glance
THE STOP TB STRATEGY
VISION A TB-free world
GOAL
To dramatically reduce the global burden of TB by 2015 in line with the Millennium Development Goals (MDGs)
and the Stop TB Partnership targets
OBJECTIVES
■ Achieve universal access to high-quality care for all people with TB
■ Reduce the human suffering and socioeconomic burden associated with TB
■ Protect vulnerable populations from TB, TB/HIV and drug-resistant TB
■ Support development of new tools and enable their timely and effective use
■ Protect and promote human rights in TB prevention, care and control
TA
RGETS
■ MDG 6, Target 6.c: Halt and begin to reverse the incidence of TB by 2015
■ Targets linked to the MDGs and endorsed by the Stop TB Partnership:

– 2015: reduce prevalence of and deaths due to TB by 50% compared with a baseline of 1990
– 2050: eliminate TB as a public health problem
COMPONENTS
1. Pursue high-quality DOTS expansion and enhancement
a. Secure political commitment, with adequate and sustained fi nancing
b. Ensure early case detection, and diagnosis through quality-assured bacteriology
c. Provide standardized treatment with supervision, and patient support
d. Ensure effective drug supply and management
e. Monitor and evaluate performance and impact
2. Address TB/HIV, MDR-TB, and the needs of poor and vulnerable populations
a. Scale-up collaborative TB/HIV activities
b. Scale-up prevention and management of multidrug-resistant TB (MDR-TB)
c. Address the needs of TB contacts, and of poor and vulnerable populations
3. Contribute to health system strengthening based on primary health care
a. Help improve health policies, human resource development, fi nancing, supplies, service delivery and information
b. Strengthen infection control in health services, other congregate settings and households
c. Upgrade laboratory networks, and implement the Practical Approach to Lung Health
d. Adapt successful approaches from other fi elds and sectors, and foster action on the social determinants of health
4. Engage all care providers
a. Involve all public, voluntary, corporate and private providers through public–private mix approaches
b. Promote use of the International Standards for Tuberculosis Care
5. Empower people with TB, and communities through partnership
a. Pursue advocacy, communication and social mobilization
b. Foster community participation in TB care, prevention and health promotion
c. Promote use of the Patients’ Charter for Tuberculosis Care
6. Enable and promote research
a. Conduct programme-based operational research
b. Advocate for and participate in research to develop new diagnostics, drugs and vaccines
1210.0020_P_001_272.indd 4 03/10/12 21:53
GLOBAL TUBERCULOSIS REPORT 2012 5
comes with a price tag of US$ 47 billion.
1
The main indi-
cators and associated targets for 2015 are summarized in
Table 1.1.
W
HO has published a global report on TB every year
since 1997 (
Figure 1.1). The main aim of the report is to
pr
ovide a comprehensive and up-to-date assessment of
the TB epidemic and progress made in prevention, care
and control of the disease at global, regional and country
levels, in the context of global targets and WHO’s recom-
mended strategy for achieving these targets. This 2012
edition – the 17th in the series – continues the tradition.
It is based primarily on data compiled in annual rounds of
global TB data collection in which countries are request-
ed to report a standard set of data to WHO (
Box 1.4). In
2
012, a total of 204 countries and territories that account
for over 99% of the world’s estimated cases of TB reported
data (
Table 1.2).
T
he report is structured in seven major chapters. Each
chapter is intended to stand alone, but links to other
chapters are highlighted where appropriate.
Chapter 2 contains the latest estimates of the burden of
d
isease caused by TB and assessment of progress towards
the 2015 targets at global, regional and country levels.
The chapter puts the spotlight on Cambodia as a new suc-
cess story in TB control at country level and for the fi rst
BOX 1.3
Goals, targets and indicators for TB control
Millennium Development Goals set for 2015
■ Goal 6: Combat HIV/AIDS, malaria and
other diseases
Target 6c: Halt and begin to reverse the incidence of malaria
and other major diseases
Indicator 6.9: Incidence, prevalence and death rates
associated with TB
Indicator 6.10: Proportion of TB cases detected and cured
under DOTS
Stop TB Partnership targets set for 2015 and 2050
By 2015: Reduce prevalence and death rates by 50%,
compared with their levels in 1990
By 2050: Reduce the global incidence of active TB cases to
<1 case per 1 million population per year
TABLE 1.1 Targets for the scale-up of interventions for TB care and control set in the Global Plan to Stop TB 2011–2015
PLAN COMPONENT AND INDICATORS 2015 TARGET
Diagnosis and treatment of drug-susceptible TB
Number of cases diagnosed, notifi ed and treated according to the DOTS approach (per year) 6.9 million
Treatment success rate (in annual cohort) 90%
Number of countries with ≥1 laboratory with sputum-smear microscopy services per 100 000 population 149
Diagnosis and treatment of drug-resistant TB
Percentage of previously treated TB patients tested for MDR-TB 100%
Percentage of new bacteriologically-positive TB patients tested for MDR-TB 20%
Number of countries among the 22 HBCs and 27 high MDR-TB burden countries with ≥1 culture laboratory per 5 million population 36
Percentage of confi rmed cases of MDR-TB enrolled on treatment according to international guidelines 100%
Number of confi rmed cases of MDR-TB enrolled on treatment according to international guidelines ∼270 000
Treatment success rate among confi rmed cases of MDR-TB ≥75%
Collaborative TB/HIV activities
Percentage of TB patients tested for HIV 100%
Percentage of HIV-positive TB patients treated with CPT 100%
Percentage of HIV-positive TB patients treated with ART 100 %
Percentage of people living with HIV attending HIV care services who were screened for TB at their last visit 100%
Percentage of people living with HIV attending HIV care services who were enrolled on IPT, among those eligible 100%
Laboratory strengthening (additional to those above)
Percentage of national reference laboratories implementing a quality management system (QMS) according to international standards ≥50%
ART, antiretroviral therapy; CPT, co-trimoxazole preventive therapy; HBC, high TB burden country; HIV, human immunodefi ciency virus; IPT, isoniazid preventive therapy;
MDR-TB, multidrug-resistant tuberculosis
1
The Global Plan to Stop TB, 2011–2015. Geneva, World Health
Organization, 2010 (W HO/HTM/ST B/2010.2).

www.stoptb.org/global/plan/
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6 GLOBAL TUBERCULOSIS REPORT 2012
time includes estimates of the burden of TB in children.
The latest status of efforts to improve measurement of TB
cases and deaths at country level, with guidance and sup-
port from WHO’s Global Task Force on TB Impact Mea-
surement, is described.
Chapter 3 presents data on the numbers of cases noti-
fi
ed to NTPs and reported to WHO and their treatment
outcomes, including breakdowns of cases by type of TB
disease, sex and age.
Chapter 4 focuses on drug-resistant TB, covering prog-
r
ess in drug resistance surveillance and associated esti-
mates of the proportion of TB patients that have MDR-TB
BOX 1.4
Data collected in WHO’s 2012 round of global TB data collection
Data were requested on the following topics: TB case notifi cations and treatment outcomes, including breakdowns by case type, age, sex,
HIV status and drug resistance status; an overview of services for the diagnosis and treatment of TB; laboratory diagnostic services; drug
management; monitoring and evaluation; surveillance and surveys of drug-resistant TB; management of drug-resistant TB; collaborative
TB/HIV activities; TB infection control; engagement of all care providers in TB control; the budgets of national TB control programmes
(NTPs) in 2012 and 2013; utilization of general health services (hospitalization and outpatient visits) during treatment; and NTP
expenditures in 2011. A shortened version of the online questionnaire was used for high-income countries (that is, countries with a gross
national income per capita of ≥US$ 12 475 in 2011, as defi ned by the World Bank)
1
and/or low-incidence countries (defi ned as countries
with an incidence rate of <20 cases per 100 000 population or <10 cases in total).
Since 2009, data have been reported using an online web-based system.
2
In 2012, the online system was opened for reporting on 16
March, with a deadline of 17 May for all WHO regions except the Region of the Americas (31 May) and the European Region (15 June).
Countries in the European Union submit notifi cation data to a system managed by the European Centre for Disease Prevention and
Control (ECDC). Data from the ECDC system were uploaded into WHO’s online system.
Data were reviewed, and followed up with countries where appropriate, by a team of reviewers from WHO (headquarters and regional
offi ces) and the Global Fund. Validation of data by respondents was also encouraged via a series of inbuilt and real-time checks of
submitted data as well as a summary report of apparent inconsistencies or inaccuracies that can be generated at any time within the
online system. Following corrections and updates by countries, the data used for the main part of this report were the data available in
July 2012.
Annex 4 was produced on 25 September 2012, by which time additional data had been reported by a few European countries.
3

Besides the data reported through the standard TB questionnaire, data about screening for TB among people living with HIV and
provision of isoniazid preventive therapy to those without active TB were collected by the HIV department in WHO and UNAIDS. The data
were jointly validated and imported into the global TB database.
1
http://data.worldbank.org/about/country-classifi cations
2
www.stoptb.org/tme
3
For this reason, there may be slight discrepancies between the main part of the report and Annex 4.
FIGURE 1.1 Sixteen annual WHO reports on TB in 15 years, 1997–2011
1997: First report:
epidemiology and
surveillance
2002: Added fi nancing and
strategy for 22 high-burden
countries (HBCs)
July 2009: Online data collection introduced
December 2009: Short update to 2009 report in transition
to earlier reporting of data and report publication
2003: Financing
and strategy
(all countries)
and extensively drug-resistant TB (XDR-TB), and the lat-
est data on the coverage of testing for MDR-TB among
new and previously treated TB patients, notifi cations
of cases of MDR-TB and enrolments on treatment, and
treatment outcomes.
Chapter 5 assesses fi
nancing for TB care and control.
Trends since 2006 are described by source of funding and
category of expenditure. Important contrasts in the extent
to which different country groups rely upon domestic and
donor fi nancing are illustrated. Funding gaps, the unit
costs of TB treatment and the cost-effectiveness of TB
interventions are discussed as well.
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