the estimated global TB incidence rate was 134 per 100 000 population, a mere 10% reduction on that of 2015 and only halfway to the first End TB Strategy milestone. The estimated number of TB deaths was 1.6 million in 2021, a 5.9% reduction from 2015 and approximately 1/5th of the End TB Strategy 2020 milestone. Lastly, in 2021, 48% of people with TB still faced catastrophic costs, which was set out to be prevented for everyone with TB by 2020. Incidence One of the purposes of TB surveillance is to measure the occurrence of new TB cases. TB case notification in high-burden countries is often incomplete due to underdiagnosis or underreporting. WHO’s TB incidence figures are estimated through different methods, such as prevalence surveys, adjusted notifications (for under-/overreporting or detection error) and inventory/capture–recapture studies. From 2020 onward, dynamic models were used to account for disruptions to health services due to the COVID-19 pandemic [5]. The majority of burden-of-disease measures in this section are based on WHO estimates in the Global Tuberculosis Report 2022 [1]. Other organisations such as the Institution for Health Metrics and Evaluation (IHME) also report global TB burden estimates, which are currently reasonably similar to those of the WHO [6]. The largest proportion of estimated new TB cases is found in the South-East Asian (45%), African (23%) and Western Pacific (18%) WHO regions, with lower proportions in the Eastern Mediterranean (8.1%), American (2.9%) and European (2.2%) regions [1]. Four countries accounted for over half of the estimated TB incidence in 2021: India, Indonesia, China and the Philippines, with 5.4 million new cases every year [1]. In 2021, 6.7% of the estimated incident TB patients were PLHIV. The African region is by far the most affected by HIV-associated TB, with a regional estimated incidence rate of 42 per 100 000 PLHIV per year, which is 4.7 times the global rate among PLHIV [7]. Four WHO regions showed a considerable decrease in estimated TB incidence in the past two decades (European 54%, African 36%, South-East Asian 34% and Western Pacific 32%), while a smaller decrease was observed in the American (22%) and Eastern Mediterranean (17%) regions [1]. The estimated incidence rate of TB among PLHIV has shown a decline from 2010 onwards, dropping from 22 to 8.9 cases per 100 000 population per year in 2021 (−60%) [1]. From 2020 to 2021, the estimated TB incidence rate increased in five out of six WHO regions, reflecting the impact of the COVID-19 pandemic (figure 1). In the African region, estimated TB incidence still declined in 2021, thereby reaching the 2020 End TB Strategy milestone of a 20% decline in TB (compared with 2015). The European region is the only other region where this milestone has been achieved. All other regions have not yet achieved the goal of a 20% decline in incidence several have a long way still to go [1]. TABLE 1 The End TB Strategy milestones and Sustainable Development Goal (SDG) targets shown as a percentage reduction on 2015 values Milestones SDG targets Status in 2021 2020 2025 2030 2035 Reduction in TB incidence rate 20% 50% 80% 90% 10% Reduction in TB deaths 35% 75% 90% 95% 5.9% Protection of people with TB from facing catastrophic costs due to TB 100% 100% 100% 100% 52% Reproduced and modified from [1, 4] with permission from the publisher. https://doi.org/10.1183/2312508X.10023922 19 EPIDEMIOLOGY |R. VERSTRAETEN ET AL.