TB Resurgence: Why Britain’s Historic Victory Over Tuberculosis is Under Threat

Tuberculosis, once relegated to history books as a disease of the past, is making an unwelcome return to Britain. England recorded 5,490 TB cases in 2024, representing a 13.6% increase from the previous year—the largest annual rise in the current reporting period dating back to 1971. This alarming trajectory has placed the nation on the brink of losing its “low incidence” status, a designation that has long been a point of public health pride.

The notification rate now stands at 9.4 per 100,000 people, just below the World Health Organization’s threshold of 10 per 100,000 that defines a low-incidence country. Provisional data suggests England may cross this threshold in 2025, marking a significant reversal after decades of steady decline. The last time TB rates were this high was 2011, when the rate peaked at 15.6 per 100,000—a reminder of how far progress has been made, yet how fragile that progress remains.

The resurgence reflects a complex interplay of factors. Approximately 80% of TB notifications in England occur among people born outside the UK, with increased migration from higher TB-burden countries following Brexit playing a significant role. The need to expand the workforce, particularly in health and social care, has led to active recruitment from nations where TB remains endemic, contributing substantially to case numbers.

However, experts emphasise that migration alone does not explain the full picture. Cases among people born in the UK also increased by 5% in 2024—the first significant rise in many years—suggesting additional factors are at play. As Tom Wingfield, reader in tuberculosis and social medicine at the Liverpool School of Tropical Medicine, noted in the BMJ analysis, there is “definitely something happening that is outside of, or additional to, migration patterns.”

Social determinants consistently emerge as critical drivers. Homelessness, poverty, drug and alcohol misuse, incarceration, and mental health disorders significantly increase TB risk and are associated with much lower cure rates. These overlapping vulnerabilities jumped by 27% between 2022 and 2023, placing already disadvantaged populations at heightened risk.

TB remains most prevalent in urban areas, with London recording the highest regional rate at 20.6 per 100,000. However, the most dramatic percentage increases are occurring in regions with historically lower TB incidence. The West Midlands saw a 22.7% increase, Yorkshire and the Humber 19.2%, and the South West 17.7%—putting significant strain on local services that were not previously equipped for high TB caseloads.

TB is also a disease of inequality. The notification rate in the 10% most deprived areas of England has risen from 15.7 per 100,000 in 2019 to 17.5 per 100,000 in 2024—more than five times the rate in the least deprived areas at 3.3 per 100,000.

A further concern is the proportion of drug-resistant TB cases. In 2024, 2.2% of laboratory-confirmed TB showed resistance to multiple drugs—the highest level since enhanced surveillance began in 2012. Whilst overall numbers remain modest, multidrug-resistant TB (MDR-TB) is significantly more challenging and costly to treat, requiring extended courses of second-line medications with greater side effects.

Experts and public health officials identify several interventions as critical to reversing the trend. The NHS England Latent TB Infection programme has expanded significantly, with 40,490 eligible migrants tested in 2024—an increase from 34,680 in 2023—with 15.1% testing positive. Early detection and treatment of latent TB infection (LTBI) in asymptomatic individuals can prevent progression to active disease.

Additional resources remain essential. Health professionals working in TB services emphasise that without increased funding for screening, diagnosis, and treatment programmes, case numbers will continue rising. The recent Coventry warehouse outbreak, which identified at least 10 people with latent TB, exemplifies how easily the disease can spread in congregate settings when prevention measures are inadequate.

The government is currently developing a new five-year National TB Action Plan for 2026 to 2031, intended to improve prevention, detection, and control. This plan will need to balance migration-related risks with targeted intervention for vulnerable UK-born populations, whilst ensuring regional TB services have the capacity to respond.

Key Takeaways

• England recorded 5,490 TB cases in 2024, a 13.6% increase, and now risks losing its low-incidence country status with rates at 9.4 per 100,000 people
• Approximately 80% of cases occur in people born outside the UK, though increases among UK-born individuals signal broader public health challenges beyond migration
• Social deprivation, homelessness, and substance misuse significantly increase TB risk, with rates five times higher in the most deprived areas compared to the least deprived
• Drug-resistant TB has reached record levels at 2.2% of confirmed cases, complicating treatment strategies
• Expanded latent TB screening and treatment programmes, supported by additional NHS funding, show promise but require sustained investment

What This Means for Kent Residents

For Kent residents, TB remains a relatively uncommon but present health concern. Whilst Kent’s TB rates are lower than London’s, residents should be aware that TB can affect anyone, particularly those with risk factors including prolonged contact with TB cases, homelessness, or substance misuse. If you develop persistent cough, fever, night sweats, or weight loss lasting more than three weeks, consult your GP urgently for testing.

Those returning from or in close contact with individuals from high TB-burden countries should discuss screening with healthcare providers. The NHS offers free TB testing and treatment for all residents. For more information, contact your local GP surgery or Kent and Medway NHS Trust services. Early diagnosis and treatment remain highly effective and break chains of transmission.