IN NUMBERS: What is the status of decades-long tuberculosis burden in PH?

For more than two decades now, tuberculosis or TB has remained one of the Philippines’ leading public health concerns. It becomes even more apparent when compared to other countries in Southeast Asia.

Data from the World Health Organization (WHO) show that the Philippines has had the highest estimated TB incidence rate per 100,000 people across Southeast Asia since 2013. Estimated incidence refers to the number of new and relapse TB cases per 100,000 people. 

TB, a contagious bacterial infection that primarily affects the lungs, is the world’s leading cause of death from a single infectious agent.

The Philippines had the fourth-highest estimated incidence rate in Southeast Asia in 2000, which slowly decreased until 2007, before it started to increase again in 2008.

Data showed a significant dip in 2020, which the WHO attributed to the COVID-19 pandemic’s effects on TB diagnosis and treatment.

After that, estimated incidence rose significantly until 2022, then decreased slightly in 2023 and 2024.

Vietnam, which has the closest population count to the Philippines, recorded a much lower estimated incidence rate over the years and it continues to decrease.

Since overtaking Timor-Leste for the top spot in 2013, the Philippines steadily maintained an average of 500 to 600 cases per 100,000 people annually for 12 years.

According to the WHO, approximately one in four people globally is estimated to carry the TB bacteria, with about 5% to 10% eventually developing symptoms and progressing to active tuberculosis.

Beyond the lungs, TB can also affect the brain, spine, and kidneys. People with weakened immune systems, diabetes, or are undernourished, as well as those who smoke heavily or consume large amounts of alcohol, are also more vulnerable.

While experts stressed that TB is highly preventable and curable, respiratory tuberculosis still ranks as the eighth leading cause of death in the Philippines in 2025 and in previous years, according to the Philippine Statistics Authority (PSA).

Third highest in TB cases worldwide

A high estimated incidence rate does not directly translate to higher cases, as population plays a bigger role.

For instance, India’s 1.4 billion population leads to the highest global TB burden despite a 178 estimated incidence, while Indonesia, with a 382 estimated incidence and 283 million people, ranks second.

In the Philippines, the high estimated incidence pulls the total cases higher on the radar screen.

In 2024, approximately 625 per 100,000 people from a 115-million population were infected with TB, which roughly translates to more than 700,000 cases — the third highest worldwide.

In its 2025 global tuberculosis report, the WHO dubbed the Philippines the third highest country worldwide bearing the burden of TB, accounting for 6.8% of global cases. It comes after India with the largest share of 25% and Indonesia with 10%.

Drug-resistant tuberculosis

TB becomes more difficult to treat when a patient does not respond to first-line drugs (FLD), such as rifampicin, or other medicines used to treat the disease. (WATCH: Rise of multi-drug resistant TB)

The WHO considers drug-resistant TB a public health threat. It cites mismanagement of TB medicines at the local level and quick person-to-person transmission as factors contributing to its persistence worldwide.

In the Philippine setup, DOH Disease Prevention and Control Bureau Director Jan Llevado said the complicated regimen for drug-resistant TB (DR-TB) compared to drug-susceptible TB (DS-TB) lessens a DR-TB patient’s willingness to get treated.

This potentially worsens DR-TB patients’ conditions and increases transmission risks for the people around them.

“For DS-TB, the multi-month course is standard. For DR-TB, the treatment is extended, so it becomes longer for severe cases. DS-TB is a fixed-dose combination. For DR-TB, it’s multiple separate individual pills. It’s really harder to treat,” Llevado said.

WHO data show that the estimated number of drug-resistant TB (DR-TB) cases in the Philippines had remained relatively stable from 2015 to 2024, but starting in 2020, it started to increase.

Estimated number of people who developed drug-resistant tuberculosis

This graph shows the estimated number of active cases that developed resistance to rifampicin, the common tuberculosis (TB) first-line drug, or to multiple TB drugs from 2015 to 2024.

Estimated cases

Uncertainty interval

Llevado attributed the increase to the DOH’s intensified annual case findings, made easier with new technologies.

She said, “GeneXpert machines can easily detect rifampicin-resistant TB. So, unlike before — when we didn’t have such technologies – it’s readily available now in local government units.”

A GeneXpert machine is a fully automated diagnostic system used to diagnose TB and detect rifampicin resistance.

Lower TB notification, constant death toll

TB does not necessarily manifest after a person becomes infected. Because some individuals remain asymptomatic, detecting TB requires screening and testing, as latent or inactive infection can progress to active disease over time.

The uncertainty of having TB discourages people from getting tested, which could increase the spread and make cases harder to detect.

Since 2018, TB notification rates in the Philippines have reflected the number of diagnosed cases per 100,000 people reported to health authorities.

Llevado said that the WHO’s estimated incidence slowly increases as more TB notifications enter the system.

While data from the Department of Health (DOH) and WHO vary, they show a similar trend: case notification rates decreased in 2020, increased in 2021, then started declining again in 2024.

The DOH director cited the COVID-19 pandemic as reason for the 2020 decline and said that because patients could not go out to get diagnosed or to get tested during the quarantine period, notification rates naturally dropped.

As of 2025, the country’s TB notification rate was 473.06 cases per 100,000 people, according to the DOH. The rate is significantly lower than the country’s estimated incidence in the given years, highlighting the challenges in recording TB cases on the ground.

An acceptable rate would be around 530 to 540 per 100,000 people, according to Llevado.

“We really have low case notification, right? So we should have improvements,” she added.

Meanwhile, data on TB-related deaths vary per source.

Source: Philippine Statistics Authority (PSA), World Health Organization (WHO)

The DOH’s data sourced from the PSA show an average of 22,000 TB deaths between 2018 and 2024.

This number has gradually increased since dipping in 2020, reaching 24,917 deaths in 2024.

The WHO’s data, however, recorded a higher number of deaths at an average of 36,000 for seven years. Deaths peaked in 2021 at the height of the pandemic, then began to decrease in 2022.

The PSA also recorded an increasing mortality rate, with 22.23 deaths per 100,000 people recorded in 2024.

The difference stems from how the PSA and WHO compile their estimates. 

The PSA relies on raw, registered deaths reported by a city or municipal registrar’s office nationwide. The WHO combines direct national reporting with statistical models based on case fatality ratios and incidence rates. It also incorporates data from partner organizations on cases that were misdiagnosed, undiagnosed, or lost to follow-up.

The DOH follows PSA data. Llevado listed client behavior, health systems capacity, social risk factors like poverty, housing, environmental risk, and unstable TB medicine supply as potential reasons for the increasing mortality rate.

“I can’t attribute it to just one factor. It’s really multifactorial. So, so many factors that really push an individual to die of TB,” Llevado added.

In 2023, the country launched the Philippine Acceleration Action Plan for Tuberculosis (PAAP-TB) for 2023-2025 — a multisectoral roadmap addressing concerns beyond health that exacerbate TB. Relevant agencies are tasked to address social protection, education, public information, labor protection, and service delivery support issues.

Aside from a national approach, Llevado also encouraged more local initiatives that address other concerns contributing to rising TB cases and deaths.

She said, “Conversations on the ground regarding TB really need to start or continue. It isn’t just a matter of testing and treatment. We also need to discuss other factors that truly contribute to TB-related deaths and incidence rates.” – Rappler.com