World TB Day 2025: Advancing the fight against tuberculosis through science and nature

World Tuberculosis (TB) Day, commemorated annually on March 24, highlights the critical need to eliminate TB. 1 According to the World Health Organization (WHO), TB is caused by the Mycobacterium tuberculosis bacterium, and it continues to represent the most fatal infectious disease globally.In 2023, the disease approximately affected 10.8 million individuals.It was responsible for approximately 1.25 million deaths, including 161,000 among people living with HIV.After three years during which COVID-19 temporarily overtook TB as the leading cause of infectious mortality, TB is once again expected to top the list in 2023, with a death toll nearly twice that of HIV/AIDS. 2The global burden of TB remains disproportionately concentrated, with 30 high-burden countries accounting for approximately 87% of total cases reported in 2023.Notably, Indonesia ranks as the second-highest contributor to the global TB cases. 3The Ministry of Health reported a significant increase in TB cases, with 821,200 detected in 2023 compared to 677,464 in 2022. 4he primary TB treatment approach follows the DOTS (Directly Observed Treatment, Short-Course) strategy, which lasts six months.Patients of TB undergo an intensive two-month phase with four key medications under close supervision, followed by a four-month continuation phase with two drugs.This regimen is recommended for all pulmonary and extrapulmonary TB cases, including children and the elderly. 5However, Indonesia's TB treatment success rate in 2023 was 86.5%, slightly below the Ministry of Health's target of 90%. 4 Treatment adherence remains a challenge due to factors such as concerns over drug side effects, long waiting times at healthcare facilities, travel distance, transportation costs, limited awareness, forgetfulness, and psychological distress. 6Poor compliance can increase the risk of relapse, treatment failure, and the development of resistance in TB strains to existing drug therapies. 7rug resistance continues to be one of the biggest challenges in controlling TB.The WHO first identified TB drug resistance in 1990, and since then, multidrug-resistant TB (MDR-TB)resistance to both rifampicin and isoniazid-has emerged as a critical global health issue. 5In 2022, approximately 410,000 people worldwide were diagnosed with MDR or rifampicinresistant TB (MDR/RR-TB).An even more dangerous form, extensively drug-resistant TB (XDR-TB), is resistant not only to first-line drugs, but also to fluoroquinolones and at least one additional second-line drug.XDR-TB cases have been reported in over 100 countries, and they have a high morbidity rate of 40-50%, posing a particularly severe threat in regions with high rates of HIV infection. 8Indonesia is one of the 30 countries with the highest burden of MDR-TB, reporting approximately 11,000 new MDR-TB cases each year.National prevalence rates demonstrate that 2.8% of new TB cases and 16% of previously treated cases are MDR-TB. 9This alarming situation is not only a consequence of microbial drug resistance but is also driven by broader social factors-such as limited access to medications, political instability, disruptions in