Broad coalition to combat drug-resistant tuberculosis in Europe

28.07.2026

Tuberculosis remains the world’s deadliest infectious disease caused by a single pathogen. In 2024, an estimated 10.7 million people worldwide developed tuberculosis, and 1.23 million died from the disease. The situation is particularly critical for drug-resistant tuberculosis: only around two in five affected individuals had access to treatment in 2024. Moreover, treatment outcomes remain substantially poorer than for drug-susceptible tuberculosis.

Shorter, fully oral treatment regimens have fundamentally improved the management of drug-resistant tuberculosis in recent years. At the same time, increasing resistance to bedaquiline and other key medicines threatens this progress. The WHO European Region bears a disproportionate share of the global burden of drug-resistant tuberculosis and, according to the authors, has the potential to take a leading role in safeguarding the effectiveness of these medicines.

The journal The Lancet Regional Health – Europe has now published a call to action by a broad coalition of professional societies and tuberculosis experts, led by the WHO Regional Office for Europe and the Research Center Borstel, entitled:

“A call to action on antimicrobial stewardship in tuberculosis: safeguarding effective tuberculosis treatment for future generations.”

The call identifies six priority areas for action:

Systematically integrate tuberculosis into national and international strategies to combat antimicrobial resistance and ensure sustainable funding for antimicrobial stewardship.
Strengthen undergraduate, postgraduate and continuing education and expand national and regional expert services for complex and drug-resistant tuberculosis cases.
Monitor the development of drug resistance, treatment adherence and treatment outcomes through robust surveillance, digital tools and cross-border collaboration.
Prevent tuberculosis and the emergence of drug resistance through infection prevention, early diagnosis and preventive treatment.
Ensure rapid and equitable access to comprehensive drug-susceptibility testing for all people with tuberculosis, including molecular and sequencing-based methods.
Ensure evidence-based, patient-centred treatment, structured support for treatment adherence and the systematic investigation of an inadequate response to treatment.

The Call to Action was developed during the 1st Conference on Antimicrobial Stewardship in Tuberculosis, held on 8 and 9 June 2026 in Chișinău, Republic of Moldova. More than 100 experts from across the WHO European Region discussed concrete steps for implementation. Among other commitments, conference participants pledged to strengthen collaboration across disciplines, institutions, sectors and national borders, expand education and research, and advocate for equitable access to diagnostics and treatment.

“Shorter and better-tolerated treatment regimens represent enormous progress for people with drug-resistant tuberculosis. However, the increasing development of resistance threatens these advances. We must therefore ensure that new medicines are used in a targeted, evidence-based and patient-centred manner from the outset. Otherwise, we risk losing their effectiveness again within only a few years,” emphasises first author PD Dr Thomas Theo Brehm, physician and scientist in the Clinical Infectious Diseases Research Group at the Research Center Borstel and the University Medical Center Hamburg-Eppendorf. “Our joint appeal is directed at policymakers, international organisations, healthcare institutions, researchers, civil society and all healthcare professionals. The life-saving medicines available today, as well as those expected to be approved in the coming years, must remain effective for future generations,” adds Dr Dumitru Chesov, also a physician and scientist in the Clinical Infectious Diseases Research Group at the Research Center Borstel, Associate Professor at the Nicolae Testemițanu State University of Medicine and Pharmacy in Chișinău, and a co-author of the call.

The initiative is supported by the Oskar Medical Prize of the Oskar-Helene-Heim Foundation.

Reference: Brehm T, Yedilbayev A, Perehinets I, Ashiru-Oredopee D, Chesov D, Lange C, for the AMS in TB Study Group. A call to action on antimicrobial stewardship in tuberculosis: safeguarding effective tuberculosis treatment for future generations. The Lancet Regional Health – Europe. 2026;67:101797. Published online: https://doi.org/10.1016/j.lanepe.2026.101797

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