It is not realistic to end tuberculosis in high-burden countries without addressing the social determinants of health

In 2024, the global progress towards the 2025 End TB milestones of reducing TB incidence and mortality by 50% and 75% respectively, stood at only 12% and 29% respectively. Although the end TB strategy emphasizes both biomedical and social interventions, country-level efforts have focused more heavily on medical approaches while paying comparatively less attention to the underlying social and structural determinants that fuel TB transmission and risk. Zambia, despite achieving remarkable progress in implementing biomedical interventions as evidenced by the high TB treatment coverage, a high treatment success rate and a comparatively high uptake of TB preventive treatment among eligible populations, continues to be a high TB, high TB/HIV, and high MDR/RR TB burden country. Without tackling the root causes of TB, high-burden countries will remain trapped in a cycle of short-term gains and long-term stagnation. Implementation of the multisectoral accountability framework (MAF) offers a practical pathway forward.