When I oversaw infectious disease control for New York City from 2011 to 2017, one of our most important public health achievements was driving the city’s tuberculosis (TB) rates to the lowest levels in history. It took decades of investment, dedication, and innovation to accomplish that.
But even during that period of success, my colleagues and I worried. We knew that TB had never truly disappeared. We feared that rising global rates of TB, combined with persistent underinvestment in domestic TB control, could one day undermine everything we had worked so hard to achieve. Unfortunately, that fear is becoming a reality.
New Data Show TB Cases Are Rising in New York City
A recent article in Healthbeat confirms what many of us in the public health field have been seeing: TB cases in New York City are rising again. In 2023, the city reported 839 confirmed cases — a 28% increase from the year before, and the highest number since 2011. This reverses decades of progress and echoes a troubling pattern that public health experts know all too well: crisis leads to investment, but as memories of the crisis fade, so does the commitment to prevention. It’s the well described cycle of panic and neglect.
Why Controlling TB Requires More Than Medical Care
TB is not a simple disease to control. It’s airborne, yes. But it’s also deeply tied to social determinants like housing, nutrition, and access to healthcare. Effective control demands a strong public health workforce for contact tracing, treatment adherence, and community outreach. It also demands stable, long-term funding. Yet, as Healthbeat reports, New York City’s TB programs are now strained by staffing shortages, federal funding cuts, and the termination of CDC support staff.
The Growing Threat of Multidrug-Resistant TB
Adding to the challenge is the global rise of multidrug-resistant TB, which complicates treatment and threatens to roll back even more of the gains we made in the 1990s and 2000s. Without sustained investment in domestic TB control — and a recognition that infectious diseases don’t require visas and stop at international borders — we risk normalizing these rising numbers.
Why Sustained Public Health Investment Matters
The public health success story of TB control in New York City was not inevitable, and it should not be taken for granted. It was built through relentless effort and investment in active surveillance, contact tracing, and directly observed therapy. If we allow the system to weaken further, the cost — in lives, dollars, and public trust — will be far greater than the cost of prevention.
Just as we see measles resurging now, it seems inevitable that the cuts to domestic and global public health funding will also lead to TB’s resurgence not just in New York City, but around the country.