Why tuberculosis matters for jobs and growth

Tuberculosis (TB) remains the world’s leading cause of death from a single infectious agent, and among the top 10 causes of death worldwide. In 2024 alone, it is estimated that 10.7 million people fell ill with tuberculosis and 1.23 million died from the disease – despite being a preventable and curable disease. The Sub-Saharan Africa (SSA) region where I work accounted for roughly 25% of all TB cases worldwide, affecting an estimated 2.6 million people.

At the World Bank Group, we are focused on creating jobs—the best way to give people income, dignity, and hope for the future and lift entire communities out of poverty. TB is a direct obstacle to this goal. Beyond the high number of deaths, it reduces workers’ productivity and ability to earn an income, affecting families, communities, and economies over the long term.

March 24 is World Tuberculosis Day, marking the date when the bacterium that causes TB was first discovered and on this day, I want to take the opportunity to highlight how TB affects labor markets—and that ending the TB epidemic is both a moral imperative and a powerful driver of shared prosperity.

Where Are We Now / Progress at Risk
Since 2000, timely TB treatment has saved an estimated 83 million lives worldwide. Without treatment, nearly half of people with active TB may die. With proper treatment, TB is curable. Early detection, timely diagnosis, and access to treatment can dramatically reduce deaths and transmission—they also enable people to return to work sooner, protecting incomes and limiting long-term economic losses.

Recent progress is worth celebrating. In 2024, the number of people falling ill with TB declined for the first time since 2020, reflecting a gradual recovery in health services after COVID-19 disruptions. More people at high risk are receiving preventive treatment, more cases are being diagnosed and treated, drug-resistant TB continues to decline, and treatment success rates are improving. These gains have averted an estimated 83 million deaths since 2000. In Africa, TB incidence fell by 28% and deaths declined by 46% between 2015 and 2024.

How TB Affects Labor Markets
TB disproportionately affects working-age adults, with over 80% of cases and deaths occurring in low- and middle-income countries. While direct medical costs are significant, the indirect costs—lost income and reduced productivity—are often catastrophic for households. Declines in worker productivity due to TB are estimated to cost $12 billion annually. Each TB case averted helps preserve labor force participation, protect incomes, and reduce poverty.

South Africa’s mining industry illustrates this clearly. The sector contributes nearly 6% of GDP, accounts for 45% of merchandise exports, and supports over 470,000 jobs. Yet TB incidence among mineworkers is among the highest (2,500-3,000 cases per 100,000 population) globally. Workers are significantly more likely to contract TB due to working and living conditions, cross-border movement, and high HIV prevalence. This leads to higher transmission, poor treatment adherence, and increased drug-resistant TB—affecting workers, their families, and the sub-region as a whole.

It is estimated that 42,000 mineworkers in South Africa have TB, with many cases going undetected. Investments in TB prevention and treatment in this sector have an estimated cost-benefit ratio of 1:40, driven by reduced deaths, increased productivity, and lower health costs—while also supporting the economic benefits of migrant worker remittances.

The Southern Africa Tuberculosis and Health Systems Support Project (2016-2024), which I had the privilege of working on, was revolutionary precisely because it focused on the epicenter of TB transmission in the region: the mining sector and the complex web of structural vulnerabilities surrounding it. By deliberately taking on a regional multi-country approach, the project addressed these underlying drivers head‑on, strengthening occupational health protections for miners and their communities, expanding access to health services, and fostering cross‑border collaboration in a region where disease does not respect national boundaries. On a personal level, the project was a powerful reminder of what is possible when ambition is matched with grit: governments, frontline workers, and regional partners pushing forward despite profound structural and logistical constraints. From portable AI-supported X‑rays bringing TB diagnosis to some of the most remote and mountainous areas of Lesotho, to countries learning directly from one another through South‑South exchanges, to mobile health clinics established at border points in Mozambique to reach migrant and mobile populations. Seeing these interventions in action underscored for me how transformative a regional approach can be when they are grounded in local realities and backed by strong political and institutional commitment.

Portable X-Ray for TB diagnosis. Photo Annie Liang / World Bank

Similar patterns are seen elsewhere. In Ethiopia, TB patients experienced a 37% reduction in productivity, a 10% drop in income, and a 78% reduction in working hours, alongside increased household costs. In Kenya, patients who completed treatment lost significantly fewer workdays than those untreated. These findings reinforce that access to timely and complete TB treatment is critical to maintaining employment and income.

The Economic Case for Investing in TB Control
From 2020 to 2050, TB could cause 31.8 million deaths and $17.5 trillion in economic losses under current trends. Achieving global TB mortality targets could avert 23.8 million deaths and $13.1 trillion in losses. The impact is especially significant in the SSA region, where TB’s economic cost was estimated at 8.4% of GDP in 2021.

Investment in TB control saves lives and it preserves workers, stabilizes households, and prevents long-term productivity losses across entire economies. Every dollar invested in TB control generates returns up to $39 in societal benefits

Scaling up screening and treatment, particularly in high-burden settings, can significantly generate even higher societal returns, while strengthening labor markets and economic resilience.

The Need for Action
Ending TB is not just a health goal—it is an investment in jobs. And it is crucial that countries, development partners, and the private sector continue to work together to redouble efforts and accelerate progress on control. Encouragingly, new partnerships continue to strengthen this collective response. The World Bank Group and the Global Fund to Fight AIDS, Tuberculosis and Malaria recently signed a Memorandum of Understanding to help developing countries build stronger and more resilient health systems while securing sustainable financing for primary health care and the fight against HIV, tuberculosis, and malaria. Through this collaboration, the two institutions aim to mobilize at least $2 billion in joint financing over the next three years to expand access to essential services and strengthen primary health care systems - an important step toward ensuring that countries have the resources and systems needed to detect, treat, and prevent TB.

The question is no longer whether the world can afford to end TB - it is whether it can afford not to.