TB Hits Hardest in England’s Poorest, Most Vulnerable
Tuberculosis (TB) stubbornly clings to England’s most deprived areas and certain urban groups. Vulnerable migrants, the homeless, those involved in the criminal justice system, people with mental health issues, and those battling drug and alcohol misuse are bearing the brunt.
Marking World TB Day, the UK Health Security Agency (UKHSA) has released its latest annual TB report with data up to the end of 2021.
Progress Stalls – England Off Track in the TB Fight
TB rates have dropped in England over the past decade, but progress has slowed dramatically in the last four years. If urgent action isn’t taken, England will miss the World Health Organization’s (WHO) bold target: a 90% cut in TB cases by 2035 compared with 2015.
TB remains the world’s second deadliest infectious disease, right behind coronavirus (COVID-19). Globally, 10.6 million people fell ill in 2021 — that’s a worrying 4.5% rise in just one year.
In England, TB notifications were at 7.8 per 100,000 people in 2021, down from 8.4 in 2019 but far from the 1.05 figure needed to hit WHO’s elimination goal. At the current pace, England will only reduce TB to 5.1 per 100,000 by 2035 — leaving us way off track. Early 2022 data shows no signs of improvement.
Impact Hits the Disadvantaged Hardest
TB cases cluster in England’s major cities, especially where poverty is rife. “Inclusion health” groups — those socially excluded with overlapping health risks — suffer most. This includes the homeless and people with contact with the criminal justice system.
These communities also face major barriers to diagnosis and treatment. Difficulties accessing care, sticking to treatment plans, and attending follow-ups mean the disease spreads unchecked.
Dr Esther Robinson, Head of the TB Unit at UKHSA, warns: “Tuberculosis remains a risk to some of the most vulnerable people in our society and this data highlights that progress towards elimination has stalled.”
“It is vital that we ensure everyone has access to timely diagnosis and effective treatment. Strengthening prevention, detection and treatment in higher risk groups is key to beating TB.”
Professor Sir Stephen Powis, NHS Medical Director, adds: “Following the COVID-19 pandemic, we’ve seen a resurgence in infectious diseases like flu and norovirus, and TB rates have crept up slightly too — although they remain lower than 2019.”
“The NHS, working with UKHSA and partners, is dedicated to improving TB prevention, detection, and control. Anyone with symptoms should contact their GP or use NHS 111 online immediately.”
Health Minister Maria Caulfield urges caution: “It is vital that we act now to protect the progress made towards eliminating tuberculosis in England over the past decade.”
“If you have a persistent cough lasting more than three weeks with a fever, see your GP right away. TB is infectious and can be life-threatening if untreated. It disproportionately harms vulnerable people, so vigilance is essential.”
Know the Symptoms – Protect Yourself
If you or someone you know has a cough that lasts longer than three weeks, especially if accompanied by a fever, speak to your GP immediately.
- Persistent cough lasting over 3 weeks, often producing phlegm or blood
- Worsening breathlessness
- Loss of appetite and weight loss
- High temperature
- Night sweats
- Extreme tiredness or fatigue
People born outside the UK make up 76.4% of TB cases, with a rate of 37.6 per 100,000 in 2021. For UK-born residents, the black-other ethnic group faces the highest rate at 19.5 per 100,000, compared with just 1.4 for the white ethnic group. Among non-UK born individuals, rates peak in those of Indian ethnicity at 99.8 per 100,000.
Through a joint TB action plan, UKHSA and NHS England are working hard to improve TB prevention, detection, and control. But without urgent vigilance and care access, England’s TB fight risks hitting a dead-end.
