{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:15:18Z","timestamp":1794003318423,"version":"4.8.0"},"reference-count":13,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries\u2019 ability to deliver uninterrupted TB services. In 2023, the region\u2019s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action.<\/jats:p>","DOI":"10.3390\/tropicalmed10120348","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T11:13:33Z","timestamp":1765538013000},"page":"348","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Ending the TB Crisis in Low- and Middle-Income Countries of the Eastern Mediterranean Region\u2014Overcoming Inaction Through Strategical Leaps"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2467-0047","authenticated-orcid":false,"given":"Santosha","family":"Kelamane","sequence":"first","affiliation":[{"name":"Regional TB Programme Group, WHO Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada","family":"Muhjazi","sequence":"additional","affiliation":[{"name":"Regional TB Programme Group, WHO Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-8855","authenticated-orcid":false,"given":"Nevin","family":"Wilson","sequence":"additional","affiliation":[{"name":"Regional TB Programme Group, WHO Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"van den Boom","sequence":"additional","affiliation":[{"name":"Regional TB Programme Group, WHO Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023). Tuberculosis Action Plan for the WHO Eastern Mediterranean Region 2023\u20132030, World Health Organization. Available online: https:\/\/applications.emro.who.int\/docs\/9789292741402-eng.pdf."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2024). Global Tuberculosis Report 2024, WHO. Available online: https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2024."},{"key":"ref_3","unstructured":"United Nations (2023). United Nations High-Level Meeting (UNHLM) on Tuberculosis. Progress Report on TB Targets, United Nations."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"World Health Organization (WHO) (2020). WHO Consolidated Guidelines on Tuberculosis: Module 1\u2014Prevention: Tuberculosis Preventive Treatment, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240001503.","DOI":"10.30978\/TB2021-2-86"},{"key":"ref_5","unstructured":"World Health Organization (2023). Tuberculosis Profile: WHO Eastern Mediterranean Region, World Health Organization."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"398","DOI":"10.5588\/ijtldopen.24.0348","article-title":"Progress in programmatic management of drug-resistant TB, WHO Eastern Mediterranean Region, 2018\u20132023","volume":"1","author":"Bennani","year":"2024","journal-title":"IJTLD Open"},{"key":"ref_7","unstructured":"The Global Fund (2024). TB Financing and Funding Gaps in Low- and Middle-Income Countries, The Global Fund. Available online: https:\/\/www.theglobalfund.org\/en\/tuberculosis\/."},{"key":"ref_8","first-page":"50","article-title":"Commitment, partnerships and operational research: Three priorities for 11 EMR countries to achieve TB elimination","volume":"1","author":"Bennani","year":"2024","journal-title":"Int. J. Tuberc. Lung Dis. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"136","DOI":"10.5588\/ijtldopen.23.0587","article-title":"2022 TB programme review in Pakistan: Strengthening governance, with better patient diagnosis and treatment","volume":"1","author":"Bennani","year":"2024","journal-title":"IJTLD Open"},{"key":"ref_10","unstructured":"Stop TB Partnership (2024). Strategies to Find the Missing Millions: Global TB Report Supplement, Stop TB Partnership. Available online: https:\/\/www.stoptb.org\/resources\/publications\/."},{"key":"ref_11","unstructured":"World Health Organization (2023). Strategy to Promote the Health and Well-Being of Refugees, Migrants, Internally Displaced Persons and Other Displaced Groups in the Eastern Mediterranean Region, WHO Regional Office for the Eastern Mediterranean. Available online: https:\/\/www.emro.who.int\/migration\/publications\/strategy-to-promote-the-health-and-well-being-of-refugees-migrants-and-idps.html."},{"key":"ref_12","unstructured":"World Health Organization (2019). Multisectoral Accountability Framework to Accelerate Progress to End Tuberculosis by 2030, World Health Organization. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/331934\/WHO-CDS-TB-2019.10-eng.pdf?sequence=1."},{"key":"ref_13","unstructured":"World Health Organization (2024). WHO Operational Handbook on Tuberculosis: Module 3\u2014Rapid Diagnostics for Tuberculosis Detection, World Health Organization. [3rd ed.]. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240089501."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/10\/12\/348\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T11:38:08Z","timestamp":1765539488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/10\/12\/348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":13,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["tropicalmed10120348"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed10120348","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]}}}