Inside Westminster’s Growing Alarm Over Tuberculosis

In a packed room at the UK’s All-Party Parliamentary Group (APPG) on Tuberculosis, chaired by Lord Nick Herbert alongside MP Sojan Joseph, a stark consensus emerged: Britain’s response to tuberculosis (TB) is no longer keeping pace with the disease itself.

The tone was urgent, at times frustrated, and occasionally incredulous. What unfolded was less a routine policy discussion and more an indictment of a system that, by many accounts, is drifting into complacency.

A Disease Misunderstood and Underprioritized

Jess Potter, speaking from a clinical and public health standpoint, set the stage bluntly: TB is still not treated with the seriousness it demands.

“This is not just another infection,” she stressed, pointing to a widening gap between political rhetoric and operational reality. Despite the UK’s low-incidence status, speakers argued that this label has bred complacency, reflected in chronic funding shortfalls, fragmented services, and inconsistent access to care.

While advancements exist, including shorter treatment regimens and evolving drug options, major barriers remain. Multidrug-resistant TB (MDR-TB) continues to challenge clinicians. Access to rifampicin is uneven. Paediatric care is especially strained, with children enduring burdensome treatment regimens involving multiple tablets or injections.

More fundamentally, Potter argued, TB has become entangled in what she called an “exclusionary politics of care.” Overstretched health systems, combined with poor housing and social determinants, mean that subtle or early TB cases are often missed.

“The situation is urgent,” she warned. “TB anywhere is TB everywhere,” a pointed critique of cuts to the UK’s overseas aid budget.

A Father’s Story: “They Didn’t Even Think of TB”

If the policy failures felt abstract, James Dunlop, a father recounting his son Finley’s illness, made them painfully concrete.

Finley, just two years old, was not initially diagnosed with TB. Clinicians suspected a foreign object. Only later did they discover granulomata forming in his lungs.

“They thought it was a Victorian disease,” James said. “TB wasn’t even considered.”

Even after surgery, anti-TB medication was administered only as a precaution. The experience exposed deep gaps, including limited clinician awareness, unreliable diagnostics, and failures in contact tracing. No clear source of infection was ever identified.

The family also faced systemic shortcomings beyond diagnosis. In Lambeth, Finley had not received the BCG vaccine due to the UK’s selective vaccination policy. His treatment involved adult-formulated drugs administered via syringes, hardly designed for a toddler. Meanwhile, his mother had to stop working, compounding the family’s financial strain.

James posed a question that lingered in the room: in a high-income country like the UK, how could this happen at all?

A Systemic Failure, Not an Isolated Tragedy

Kinz-ul-eman broadened the lens, arguing that cases like Finley’s are not anomalies but symptoms of systemic neglect.

“We know everything,” she said. “So how did a British child go through this?”

Her critique cut across borders. While TB is often framed as a disease of low and middle income countries, she noted that high-income settings frequently fail to diagnose it promptly. In some cases, clinicians may pursue invasive cancer diagnostics before even considering TB.

Screening remains inconsistent. Active case finding, particularly among high-risk groups such as migrants and prison populations, is limited. Surveillance systems are underfunded.

The paradox, she argued, is striking. TB remains one of the world’s deadliest infectious diseases, yet it is neither treated as a current pandemic nor adequately prepared for as a future one.

Drug Shortages and Regulatory Deadlock

Perhaps the most striking intervention came from a TB clinician in Birmingham, who described a system increasingly unable to guarantee basic treatment.

“We’ve run out of drugs,” they said, adding that in some cases, patients might receive better TB care in lower income countries than in the UK.

At the heart of the issue is a regulatory and market failure. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE) create a bottleneck. Drugs without sufficient market demand struggle to gain approval, even if they are clinically effective.

The result is a catch 22. Unlicensed drugs exist but are inaccessible.

Speakers pointed to Spain as a potential model, where hospitals can request unlicensed medications through a centralized system on a case by case basis. The contrast with the UK system, they argued, is stark.

Rising Cases, Hidden Mortality

Concerns were also raised about a reported 13.6% rise in TB cases in 2024. Yet even this figure may not capture the full picture.

Mortality, estimated at 3.8% or roughly 1 in 25 cases, remains largely invisible in public discourse. TB, several participants noted, is simply not on the political radar in the way other infectious diseases are.

This invisibility has consequences. Without public pressure, funding remains stagnant. Without funding, systemic weaknesses persist.

Lessons Ignored and Lessons Available

A recurring theme was the UK’s reactive approach. Contact tracing is inconsistent. Systematic screening is rare. Active case finding, proven effective in other contexts, is not widely implemented.

One participant drew a comparison with meningitis outbreaks. While the diseases differ, the response to meningitis, rapid, coordinated, and proactive, offers a model.

“Take initiation and end it like we are doing for meningitis,” a pediatric specialist urged.

The implication was clear. TB requires the same level of urgency and coordination.

The Political Stakes

For policymakers in attendance, the discussion carried clear political implications.

“If we lose TB low-incidence status,” one speaker warned, “it will be shameful.”

Yet the meeting stopped short of specifics. No clear funding targets were proposed. Strategies for raising awareness, scaling systematic screening, or implementing nationwide active case finding remained underdeveloped.

A Narrow Window for Optimism

Despite the grim tone, there were glimmers of optimism. New diagnostic tools, improved drug regimens, and the prospect of next generation vaccines offer hope.

But as multiple speakers emphasized, tools alone are not enough.

What is needed is political will. Sustained investment, stronger accountability, and a shift from reactive to proactive public health strategy!

Thank you for reading, please do check out the report made by the APPG and Result UK!

Written by,

Neilay Bhalerao