World TB Day March 24, 2026

Every year World TB Day falls on March 24^th. On this date 144 years ago the German immunologist Robert Koch first demonstrated the existence of the TB bacterium. At the same time he showed how to identify it in a TB patient with active disease – through so-called ‘sputum microscopy’.

Sputum microscopy actually isn’t a very reliable or sensitive diagnostic because it requires a good dollop of hawked up sputum from the patient – and in many TB cases this is really difficult to manage (particularly with children but also for anyone who’s immune-compromised.

It’s a very sorry fact that, almost a century-and-a-half after Koch made his famous presentation in Berlin, most TB cases that are bacteriologically confirmed are still being diagnosed by this method. Similarly, all four first line TB drugs are all between 50 and 70 years old. And 'similarly-similarly' the only vaccine (which isn’t really effective anyway) is over a hundred years old too.

It should be added that today there are new and better diagnostics, and there are also new drugs – but they’re simply considered too expensive or unmanageable to be used in TB endemic countries where they're most needed (which also happen to be characterised by their poverty).

We can’t help but wonder what Robert Koch would make of this appalling inequality and unnecessary disease and death given that TB remains humanity’s most lethal infectious enemy.

Yesterday we attended a TB Symposium in London entitled TB in a Changing World. It was hosted by UCL (University College, London) and the London School of Hygiene and Tropical Medicine and was an interesting event. The title comes across to us as a tiny bit ironic given that so little changes with TB, with the neglect running on and on. We can summarise some of our key take-homes as follows.

Extra-Pulmonary TB (and TB of the lymph node)

This is TB disease that affects any part of the body outside of the lungs, something which makes it extremely difficult to detect (useless trying to diagnose it with sputum microscopy, for instance). It most often occurs in children (frequently with frighteningly rapid mortality from TB meningitis) as well as in folks with severe immune deficiency.  What was unusual in respect of other TB symposia we've attended was that some time was spent discussing aspects of EP-TB,  mainly focusing on TB in the lymph nodes (what was once termed ‘scrofula’). What emerged for us was quite an eye opener.

Disappointingly, there’s currently very little focus on EP-TB from epidemiologic perspectives. This is because EP-TB is generally non-infectious (unlike TB in the lungs) so doesn’t contribute to the ongoing cycle of TB disease. Such neglect is a scandal nevertheless because around on-in-six TB cases globally are reckoned to be extra-pulmonary (so over 1.5 million new cases each year). But frankly no-one knows for sure – and largely because of this uncertainty there’s even less of an idea as to what sort of ‘case fatality rate’ can be attributed to it. It’s posited at around 7% of all cases but, given the lack of knowledge this percentage can hardly have much confidence attributed to it. In fact it's reported that untreated  ‘miliary TB’ (which is one form of EP-TB that comprises around 4% of all diagnosed TB in the UK) has been reported as being ‘almost uniformly fatal’ within 12 months of diagnosis. That’s a fatality rate that is a lot higher than 7% if the disease remains undiagnosed.

EP-TB may, however, help explain why there are so many recurrent or relapsed pulmonary TB cases that recur after treatment. A bacteriologically-confirmed successfully-treated pulmonary TB case (i.e. one who’s confirmed as having TB  by Koch’s sputum microscopy or by another approved diagnostic and then put on standard DOTS treatment) can go through six months of  TB treatment and most are then deemed officially  ‘cured’. Such a status is determined by their being bacteriologically negative at six months and by completing those six month of multi-drug treatment – but if a quantity of the mycobacteria have managed to somehow hole up in the lymph nodes then the story may not be over. If this oocurs (and it seems possible that it sometimes does) then despite this lengthy and pernicious drug treatment regimen the body cannot have been effectively sterilised of the infection: in other words, such a patient is not actually really cured and the disease can recur.

Does such lymph node EP-TB explain why these recurrences/relapses are so frequent? It could do (in which case there is a lot of further understanding waiting to be explored here). And if the mortality rates of such recurrent cases are higher than with newly diagnosed first-time cases (as they probably are though there’s no data available to tell us either way) this could be something important.

But lymph node TB begs another intriguing question too – because the lymph nodes are where immune cells are housed – in fact they comprise the densest home of immune cells in the whole body. So does lymph node TB offer us evidence of the TB mycobacterium’s most cunning trick – does it effectively represent he pathogen’s Trojan Horse?

The answer is that we don’t know either how or why it finds a home in the lymph nodes, but it’s certainly possible. What’s disturbing, though, is that such a question doesn’t just remain unanswered, it pretty much remains unasked as well! – and this is 33 years after TB was officially declared a Global Emergency (in 1993).

The truth is that many of today’s deficiencies of understanding of EP-TB can be very simply explained because they're still based on large retrospective series that were performed decades ago and remain unreviewed because of the serial neglect in researching this complex disease. This is a very serious issue because these understandings could be massively improved with the benefit of improved diagnostic and imaging resources that are regularly used in today's biomedicine (by nucleic acid amplification, computed tomography [CT], magnetic resonance imaging [MRI] etc.).

And as a scant aside that also begs further questions, in the late Middle Ages lymph node TB (termed ‘scrufula’ or also sometimes as ‘the king’s evil’) appears to have been a lot more common than it is today. There was also a wide-spread belief that it could be cured by the touch of the sovereign.

TB and climate change

It was particularly good to see an excellent presentation on the potential impact on rates of TB courtesy of Climate Change. War, migration and poor nutrition are all well accepted to contribute to increasing incidence of disease (and poorer outcomes of course). With USAID being shredded and foreign aid reduced by both the UK and the EU this situation feels very perilous.

It was stated that 20 million people found themselves displaced by conflict in 2024 or by climate, and an estimated 733 million faced hunger for similar reasons. All of them simultaneously face higher risks of TB disease

Just a quick aside comparing military spending and TB in order to enrich perspectives on these sorts of anomalies and risks

In the U.S. the White House is currently seeking an additional $650 billion ($650,000,000,000) in military spending to help fund its wildly ill-conceived militarist ventures.

This sum amounts to over 18 times the last operating budget of USAID before it was peremptorily demolished last year with as yet uncalculated negative effects on TB control (and we suspect particularly on MDR-TB). Eighteen times more money being spent on killing than being spent on protecting the human family's most vulnerable...

With regards specifically to TB funding and this astonishing request for extra military spending looks MUCH worse. The global budget that was unanimously set for TB treatment and research three years ago at the high-level meeting on TB at the UN (UNHLM) required that US$22 billion would be being spent each year on TB treatment by 2027, along with US$5 billion on Research. Added together these sums amounts to a pitiful 24th of what the White House wants as extra cash for waging its wars. But those targets still aren’t anywhere near being met! What was actually spent on TB treatment and research in 2024 (the most recent year for which data is available) was MUCH less than these targets. The total spent on TB treatment, for instance, was less than US$6 billion, and the total spent on TB R&D was just US$1.2 billion. Added together, this comes to an appalling 90^th of the White House's demand for extra cash for killing.

Is it time that we demand that political priorities are appropriately reviewed?

And finally a few thoughts about moxa arising from yesterday’s symposium

As usual, we made every effort we could at the symposium to approach potential academics to share some of our findings about moxa and host immunity and hopefully garner some interest.

What was unusual and interesting yesterday was that there was one brief presentation on some research that, in some respects, mirrors what we believe moxa does when supporting recoveries from TB (which is by acting as a ‘host-directed’ therapy that might help the body expel or push back the TB pathogen).

Two drugs were discussed in this respect, both of which have yet to be tested in human trials, but one of which (imatinib, which is approved to treat certain types of cancer) has shown significant promise with animal studies.

But there’s a catch because the correlate human dosage of this drug is ten times higher than the highest dosage that’s considered safe in human beings. This shows how pharmacological immunotherapy is so incredibly complex and really tricky (which is why it’s so frequently neglected as a therapeutic target). This makes it so terribly sad that there is still such a dearth of interest in developing the further necessary research into moxa – especially since moxa comes with a general safety profile that's two millennia old, with over fifteen hundred years of documentary reports of successful outcomes treating TB disease, and a Moxafrica-associated tiny cluster of clinical research with exciting results that desperately need further testing.

All we are saying is give moxa a chance….