Europe’s Tuberculosis Rates Remain Alarmingly High, Detection Gaps Persist

Modern surveillance data reveals that Europe continues to struggle with high rates of tuberculosis (TB), particularly drug-resistant strains, and a significant number of cases remain undiagnosed. A joint report from the World Health Organization (WHO) Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC) highlights the challenges in meeting regional and global TB elimination goals.

Key Findings from the 2026 Surveillance Report

• 161,569 new and relapse TB cases were reported from 51 out of 53 countries in the WHO European Region in 2024, equating to 17.2 cases per 100,000 people.
• WHO estimates 204,000 people fell ill with TB across the WHO European Region in 2024.
• Approximately 1 in 5 estimated cases in the European Region remain undiagnosed or unreported.
• 23% of new TB cases in Europe are multidrug-resistant, compared to a global average of 3.2%.
• 51% of previously treated TB cases in Europe are resistant to rifampicin, versus 16% globally.
• 38,249 cases of tuberculosis were reported in 30 EU/EEA countries in 2024, resulting in a notification rate of 8.4 per 100,000 population.
• 4.2% of all new and relapse cases are in children under 15 years of age.
• 3.5% of new TB cases are multidrug-resistant in the EU/EEA.
• 22% of people who started on TB treatment in the EU/EEA are not evaluated after one year.
• All three extensively drug-resistant TB cases reported in the EU/EEA, from the 2021 cohort, resulted in death.

Persistent Detection Challenges and Drug Resistance

The report underscores two critical issues: a persistent gap in TB detection, with one in five cases going undiagnosed or unreported, and alarmingly high levels of drug resistance, significantly exceeding global averages. These issues are interconnected; delayed diagnosis increases the risk of transmission and contributes to the development of drug-resistant TB.

While TB incidence in the WHO European Region has decreased by 39% since 2015, and TB-related deaths by 49%, progress is falling short of the End TB Strategy’s 2025 milestones of 50% and 75% reductions, respectively. Similar trends are observed within the EU/EEA, where cases have decreased by 33% and deaths by 17%, but most countries are unlikely to meet their 2030 targets.

Gaps in Detection and Follow-Up

In 2024, only 79% of the estimated new and relapse TB cases in the WHO European Region were officially reported, leaving a substantial number of individuals undiagnosed and untreated. This diagnostic gap has significant consequences, as undiagnosed individuals continue to transmit the disease within their communities. Within the EU/EEA, notification rates have stabilized, but challenges remain in diagnostic capabilities and consistent follow-up care due to limitations in healthcare systems. One in five individuals initiating TB treatment in the EU/EEA lack evaluation after one year, a gap that extends to children under 15.

“One in five people with TB in the European Region are still being missed by health services. That is not only a failure in detection – it is a missed chance to treat earlier, prevent suffering and stop further transmission,” said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe. “We have made progress, with TB incidence down by 39% and deaths down by 49% since 2015. But we are still not moving fast enough, and drug-resistant TB remains one of the most serious threats we face. In the words of this year’s World TB Day theme: yes, we can end TB — led by countries and powered by people. By investing in rapid diagnosis, shorter all-oral treatment regimens and stronger follow-up, countries can reach more people earlier, improve outcomes and place us back on track toward our targets.”

Dr. Pamela Rendi-Wagner, ECDC Director, added, “During the past decade, EU and EEA countries have seen the number of TB cases decrease by 33% and the number of deaths by 17%. This progress is the result of the strong commitment in the Member States and of our joint efforts. To achieve the 2030 targets, continued efforts and collaboration are needed in early detection and sustained follow-up to support people already diagnosed with TB.”

Drug Resistance: A Regional Emergency

The WHO European Region bears a disproportionately high burden of rifampicin/multidrug-resistant TB. Drug-resistant strains are more difficult to treat, requiring longer and more complex regimens, and are associated with significantly higher mortality rates. In 2024, there were 26,845 confirmed cases of rifampicin-resistant or multidrug-resistant TB across the European Region, with 817 cases in the EU/EEA. These figures represent roughly seven times the global average for rifampicin-resistant cases and three times the global average for multidrug-resistant cases.

Treatment success rates for multidrug-resistant TB in the EU/EEA are only 56%, allowing drug-resistant strains to persist and spread, highlighting the urgent need for improved diagnosis and care.

Additional Findings

• TB/HIV Co-infection: An estimated 23,000 HIV-positive TB cases were recorded in the European Region, with 80% concentrated in the Russian Federation (52%) and Ukraine (28%). Despite high HIV testing rates among TB patients (93%), antiretroviral therapy coverage remains below WHO targets.
• Treatment Success: Treatment success rates in the European Region remain below targets, at 74% for incident TB and 66% for RR/MDR-TB, compared to targets of 90% and 80%, respectively. EU/EEA overall treatment success stands at 64% against a WHO target of 90%.
• Prison Populations: People in prison in the EU/EEA face a TB notification rate of 121.6 per 100,000—a 13.2-times greater relative risk compared to the general population. Data reporting on TB in prisons remains inadequate.
• Children and Geographic Inequality: Several countries in the European region report a child TB notification rate of over 10 per 100,000 for ages 0–4, illustrating persistent within-region disparities.

Call to Action

WHO/Europe and ECDC are urging Member States and European institutions to prioritize the following actions:

• Intensify TB prevention and early case detection, focusing on high-risk and marginalized populations, including those in prison.
• Expand access to rapid diagnostics and drug-susceptibility testing, particularly in high-burden settings.
• Scale up shorter, all-oral treatment regimens for drug-resistant TB to improve patient outcomes and reduce treatment loss to follow-up.
• Strengthen integration of TB and HIV services and improve antiretroviral therapy coverage for co-infected individuals.
• Improve surveillance reporting on HIV co-infection, TB in prisons, and treatment outcomes to support evidence-based policymaking.

The Tuberculosis Surveillance and Monitoring in Europe 2026 report is a joint publication of the WHO Regional Office for Europe and the European Centre for Disease Prevention and Control (ECDC). The data presented covers the 2024 surveillance year across the 53 countries of the WHO European Region and 30 EU/EEA countries. All TB burden estimates cited are drawn from the WHO Global Tuberculosis Report 2025.