‘TB SUITCASES’ PROVIDE HIGH-TECH HOPE IN THE FACE OF LOOMING FUNDING CUTS
On a tiny atoll in the middle of the Pacific Ocean, where electricity can vanish with the tide and transport to the capital only runs when weather allows, a health worker unpacks their ‘TB suitcase’.
Inside is a piece of technology that could transform the way tuberculosis (TB) is detected and treated in some of the world’s most remote regions: a battery-powered portable x-ray machine, with an AI programme capable of analysing chest scans and flagging potential cases within minutes.
“This machine is one of the game changers when it comes to the Pacific Island countries,” Mr Ludo Bok, team leader for health at the United Nations Development Programme’s (UNDP) Pacific Office, told the Telegraph.
“[These nations] may not have huge numbers [of cases], but their TB rates are among the highest in the world. That’s why this portable tech is such a breakthrough – it helps us find and treat cases quickly, especially in remote areas where delays can be dangerous.”
One such such place is Mili Atoll – one of the outermost spots in a chain of low-lying islands and coral atolls that make up the Marshall Islands.
In February, clinicians packed a black ‘TB suitcase’ onto a boat and travelled some 75 miles south from the capital Majuro to Mili – a trip that takes 24 hours. Over five days, they went to six villages across the atoll, unloading the compact case and operating the x-ray in weathered rooms acting as temporary clinics. Of 497 people x-rayed, 17 were diagnosed with potential TB and 91 had latent infections – those affected started treatment immediately.
“Before we used a bigger portable x-ray… but it took six people to carry and needed electricity,” said Risa Bukbuk, the national TB program manager at the Marshall Islands’ Ministry of Health. “Some atolls don’t have big roads, so it was challenging to lift it into small boats – especially when the sea was rough – or to carry it when there was no dock or wharf.
“The [new x-ray] also has much better images, according to the clinicians, and we can take it anywhere, even without electricity. That makes it really convenient,” she added.
According to the World Health Organization (WHO), it is these sorts of innovations that could prove critical if a post-Covid recovery in tuberculosis treatment is going to be sustained in the face of slashed aid budgets.
In an annual report published on Wednesday, the UN agency said the world has finally recovered from pandemic-era disruption. While TB remains the deadliest infectious killer globally, with 1.23 million fatalities in 2024, deaths and estimated infections declined last year for the first time since Covid struck.
What’s more, a record 8.3 million cases were officially diagnosed – almost 80 per cent of the 10.7m people estimated to have contracted the disease. This increase in diagnoses sounds negative, but it means that detection rates are improving – the first step in ensuring people have access to life-saving treatment.
Although only 42 per cent of the 390,000 people with drug resistant TB in 2024 were treated, there has been an overall drop in these cases. Meanwhile 88 per cent of people with drug-susceptible cases were cured after the first round of treatment.
“We see positive trends [and] that shows that progress is possible, and it encourages us that with the new tools we can we can do our best to improve access,” Dr Tereza Kasaeva, the director of the department for HIV, TB, Hepatitis and STIs at the WHO, told a press briefing this week.
But she added that these gains still fall short of the targets set – and international aid cuts, on top of already tight budgets, could deliver a substantial blow to the tentative progress.
“A major obstacle is global funding for TB, which has stagnated since 2020,” said Dr Kaseva, adding that “cuts to funding from 2025 onward pose a serious challenge”.
“In our report, you will see that the Covid pandemic is over, but we are still recovering from these disruptions of access to the services,” she said. “And now, we are alerting that another disruption due to the cuts of funding may lead also to the same results.”
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Dr Kaseva referred to modelling studies which estimated long-term cuts could result in some two million additional deaths and 10 million extra cases between 2025 and 2035, as healthcare workers have lost their jobs, clinics have seen drug stock outs, and TB research trials have been suspended. Many of these impacts have already been seen, especially in Africa.
There are also concerns about reduced funding for the Global Fund – an initiative to tackle HIV, TB and malaria that’s widely considered highly effective. But at the G20 later this month, the fund is not expected to reach its replenishment target - the UK said this week it would commit £850m, a 15 per cent reduction since 2022.
“Even short-term disruptions to funding could lead to hundreds of thousands of excess deaths,” said Dr Kaseva. “Drops can happen quite fast, but recovery can take years.”
To reduce the blow, the WHO and others are encouraging countries to contribute more of their own domestic budgets to tackle tuberculosis, rather than rely on international aid.
AI ‘already our reality’
“There are a few countries we know of that have increased domestic financing – Indonesia, Nigeria, South Africa,” Dr Yogan Pillay, director for HIV and TB delivery at the Gates Foundation, told the press briefing.
“But it’s true that TB has historically been underfunded, so… what’s come recently is just adding to an already tough situation for most countries with high TB burdens. But we would like to encourage all countries to increase domestic financing for TB, like they did when HIV was at its peak,” he said.
But there is also a drive to make the most of new technology on offer – which may not just improve access to diagnosis and treatments, but allow healthcare workers to do more with less.
“We’re excited about the opportunities that are given by new technologies – and AI devices, they are not our future, it’s already our reality,” said Dr Kaseva. “We’ve seen immediately after introduction [of]… this to technology a positive impact. It addresses the chronic, persistent problems in access to the services – when you can’t reach services, they may come to you.”
The ‘TB suitcase’ is one such initiative.
UNDP’s Mr Bok stressed it’s not only improving access, but cost-effective. The Fuji x-ray itself costs about $120,000 per machine, but that includes a warrant and the AI technology. The old x-rays were $110,000 – and required more people to operate.
He added that it can also help plug holes in capacity, especially in regions like the Pacific where many health workers move abroad in search of better opportunities.
“It’s like giving frontline health workers a second pair of eyes. The AI can flag cases with over 95 per cent confidence, which means we’re catching TB that might otherwise be missed – especially in places where there’s no doctor or radiologist around. That’s a big deal out here,” Mr Bok said.
That’s not to say the rollout has been entirely smooth – for instance in the Marshall Islands, which is one of six Pacific nations already using the ‘TB suitcase’, a long wait to secure a part for a malfunctioning element of the x-ray meant a screening programme planned for November was postponed.
Still, the AI and hyper-portable x-rays are not the only innovations raising hopes. The WHO report said that, as of August 2025, there were 18 TB vaccine candidates in clinical trials – including six candidates in phase three trials.
The pipeline for rapid diagnostics has also “expanded considerably”, with 63 tests in development, while 29 new drugs for TB are in clinical trials – and there are rising hopes that a two-month regime is not far away. At the moment, the standard treatment involves taking a cocktail of drugs for six months.
“I think this is where, for the first time, I’m really optimistic… about the potential of these new tools,” said Dr Pillay.
“So we have new tools on the diagnostic side, especially low cost molecular tests, that can be used in clinics and in communities. We have the potential of shorter duration regimens for the treatment of TB. We are hopeful to get a two month regimen, including an injectable for TB treatment. And thirdly, we have the potential and the promise of a vaccine, or vaccines for TB, especially for adolescents and adults.
“So there’s lots of promise on new tools, but we need to ensure that the new tools come more rapidly, that they are affordable and that they are taken up by countries as soon as possible.”
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2025-11-12T16:30:51Z
