TB Cases Soar in Tower Hamlets, Placing British Bangladeshi Community at Risk

Tower Hamlets is grappling with a significant public health challenge as tuberculosis (TB) cases continue to rise, with an average of 66 cases reported annually over the past three years. This troubling trend is mirrored across the UK, but is particularly acute in areas with large immigrant populations, such as Tower Hamlets, home to a prominent British Bangladeshi community.

According to the latest provisional data from the UK Health Security Agency (UKHSA) for 2024, there was a 13% increase in TB notifications in England, with a total of 5,480 cases. London remains the region with the highest TB rate in the country, at 18.7 per 100,000 population in 2023. These figures are a stark reminder that while England is still considered a "low incidence" country by the World Health Organization (WHO), it is not on track to meet the WHO's elimination target by 2035.

Understanding the TB Disparity in Tower Hamlets

The high incidence of TB in Tower Hamlets is directly linked to its demographic makeup, particularly the British Bangladeshi community. While anyone can contract TB, certain factors increase the risk, and these are disproportionately present within this community:

• Socioeconomic Factors: TB is often referred to as a "disease of poverty." Tower Hamlets has a higher rate of deprivation and overcrowding compared to the national average. Overcrowded living conditions create an ideal environment for the airborne transmission of the TB bacterium.
• Historical Ties to High-Incidence Regions: A significant portion of the British Bangladeshi population has familial ties to Bangladesh, a country with a high burden of TB. This connection means that international travel and social networks can contribute to the reintroduction and spread of the disease.
• Barriers to Healthcare: While efforts are being made, some community members may face language, cultural, or structural barriers to accessing healthcare. This can lead to delays in seeking a diagnosis and completing the long course of treatment, increasing the risk of transmission and the development of drug-resistant TB.
• Social and Community Networks: The close-knit nature of the community, while a source of cultural strength, can also facilitate the spread of the disease through regular social and family gatherings.

The UKHSA data shows that in 2024, 81.5% of all TB notifications were among individuals born outside the UK, highlighting the strong link between TB incidence and country of origin. The most common countries of birth for non-UK born individuals with TB include India, Pakistan, Romania, and Bangladesh.

Local and National Response

In response to the rising numbers, the UKHSA and local authorities, including the Tower Hamlets Public Health team, are implementing targeted programs. These include:

• Targeted Screening: A program for babies and children at high risk of exposure to TB has replaced the universal BCG vaccination. Additionally, efforts are being made to screen migrants who have arrived from high-incidence countries.
• Community Outreach: The Tower Hamlets council is conducting outreach work to "hard to reach groups" and creating TB awareness resources in various languages, including Bengali, to support community education.
• Directly Observed Therapy (DOT): To improve treatment completion rates, a crucial factor in preventing drug-resistant strains, some areas are piloting a system where patients can receive directly observed therapy (DOT) at local pharmacies. This ensures they take their full course of medication.

Despite these efforts, the data shows that the work is far from over. In 2023, only 84% of drug-sensitive TB patients completed their treatment, and a small but significant number of people died from the disease. The continued rise in cases underscores the need for a sustained, integrated public health strategy that addresses both the medical and socioeconomic factors driving the epidemic in communities like Tower Hamlets.