Tuberculosis Resurgence: The Hidden Cost of Inequality

A young university student comes to the clinic accompanied by his mother, who is concerned about his progressive weight loss. She complains that her son eats well and is well catered for. I glance at his wristwatch, shoes, iPhone and agree with her analogy, money is not a problem. Tests done at the university clinic reveal nothing significant yet; her boy returns home every holiday looking thinner.

Her first thought was drugs; despite his numerous denials, she dragged him to a lab for urine toxicology, which turned out to be negative. She decides to bring him to the hospital for proper evaluation; could it be cancer, she queried?

Numerous tests were done, the results are back, and I sit with the boy and his parents to discuss the findings.

The young man has Pulmonary Tuberculosis.

His father looks up from his expensive frames with a scornful look: “TB? Doctor, you mean people still have TB?”

My dear, you have no idea.

For many of us trained in medicine in the last two decades, tuberculosis (TB) feels like an old friend. It is a disease we understand, a disease we learnt to manage, even to control. We were taught that TB was ancient, predictable, and, crucially, preventable. We had the Bacillus Calmette Guérin (BCG) vaccine. We had treatment protocols. We had directly observed therapy. We had algorithms. We had hope.

Once upon a time, we blamed TB’s persistence on HIV. The narrative was neat and comforting. HIV weakened immune systems; TB took advantage. Africa bore the brunt of both, and the numbers soared. TB became the leading killer of people living with HIV. It made sense. We rallied resources, rolled out antiretroviral therapy, integrated TB and HIV services, and gradually, something remarkable happened. HIV-related deaths declined. Viral loads became undetectable. Life expectancy improved.

And then gradually, in the past few years, Tuberculosis has made a quiet comeback.

Even as HIV incidence dropped in many regions, TB numbers continued to rise globally in high-income countries and low-income ones, megacities and rural settlements, in refugee camps and urban slums; everywhere you turn, the incidence of TB is increasing.

Globally, the scientific discourse is shifting.

We often talk about vaccination as if it were a magic shield. But the BCG vaccine, despite its value, has limitations. It protects young children from severe forms of TB, such as meningitis and disseminated disease. It does not reliably prevent pulmonary TB in adults, which is the form that spreads most easily. Many people do not know this. We speak of “the TB vaccine” as though it were equivalent to measles or polio vaccines. It is not. And yet, in many parts of the world, BCG coverage is also declining, disrupted by conflict, weak health systems, misinformation, and competing health priorities.

TB thrives where the immune system is compromised, but immunity is shaped by far more than viruses. Malnutrition is one of TB’s oldest allies. A body starved of protein, micronutrients, and calories cannot mount an effective immune response. Today, global hunger is rising again, reversing decades of progress. Inflation, climate change, conflict, and displacement have pushed millions into food insecurity. TB does not need an invitation in such conditions. It simply walks in.

Then of course there is poverty- not as an abstract concept, but as lived reality. Poverty determines where you live, how many people share your room, whether you can open a window, whether you can afford transport to a clinic, whether you complete six months of treatment or stop halfway because you feel better and need to return to work. TB treatment is long, unforgiving, and socially disruptive. Miss doses, and the bacteria learn. Drug-resistant TB is not a mystery; it is a predictable outcome of systems that demand perfect adherence from people living imperfect lives.

We must also reckon with the world we have built, one that is more crowded, more mobile, and more unequal than ever before. Rapid urbanisation has created dense informal settlements where ventilation is poor, and health services are distant. Migration, whether driven by economic survival or violent conflict, brings people into close contact under stressful conditions. TB spreads silently, long before symptoms become severe enough to force someone into care.

And then of course, we had COVID-19.

The pandemic did not just kill millions; it destabilised health systems globally. TB services were disrupted. Screening programmes were paused. Diagnostic machines were repurposed. Health workers were reassigned. Patients stayed home, afraid, locked down, or forgotten. TB did not disappear during those years; it simply went undetected. Now, the backlog is surfacing, and the numbers look like a surge. In reality, it is a reckoning.

We should also be honest about infectious disease fatigue. The world’s attention moves quickly. Emergencies attract funding; chronic problems do not. TB is slow, politically inconvenient, and deeply tied to social injustice. It does not make for dramatic headlines until it mutates into something drug-resistant and deadly. Even then, the outrage is brief.

And so when the rich, elite population ask ridiculous questions like ‘Does TB still exist?’, it reflects how truly ignorant we are about this world.

Tuberculosis is not just a medical problem. It is a mirror. It reflects how we feed our populations, how we house them, how we value labour, how we respond to poverty, and how we design health systems. It exposes the limits of vaccines when social conditions remain hostile to health. It reminds us that disease does not exist in isolation; it is embedded in economics, politics, and policy. That is why a rich student in the university can get infected with TB simply by staying in the same hostel with another person who has a chronic cough.

The story of TB today is not one of scientific failure alone. It is a story of fragmented priorities, underinvestment in primary healthcare, and nutrition programmes treated as charity rather than infrastructure. Of global solidarity that flares during crises and fades during recovery.

TB’s resurgence is not asking us for a new miracle drug or a perfect vaccine, even though both would help; it is asking us harder questions. Are we willing to confront poverty as a health issue? Are we willing to invest in nutrition, housing, and strong health systems with the same urgency we bring to pandemics? Are we willing to accept that some diseases persist not because we lack knowledge, but because we tolerate inequality?

The young man got better, but his diagnosis never left my consulting room. His parents told everybody who cared that he had a ‘chest infection’ (which is technically accurate) and immediately got him a room off campus where he could stay alone. No more mixing with the ordinary folks.

Another win for inequality.

Nigerians can now invest ₦2.5 million on premium domains and profit about ₦17-₦25 million. All earnings paid in US Dollars. Rather than wonder, click here to find out how it works.

Join Daily Trust WhatsApp Community For Quick Access To News and Happenings Around You.