Hiding TB, Crippling the Nation
Fourteen lives are lost every hour. Not because of earthquakes, not because of traffic accidents, but because of a disease that is entirely curable. Tuberculosis—a disease still regarded by some as a relic of the colonial era—is in fact killing more than 125,000 Indonesians every year. And this is not merely a figure in a health report; each victim is a father, mother, child, or worker lost from the midst of their family and community.
What makes this problem all the more bitter is the fact that this country actually knows how to cure it. TB medication is available, and is even provided free by the government. The medical knowledge is clear, the programme budget exists, and the national strategy has been set out in Presidential Regulation Number 67 of 2021. Yet TB continues to run rampant, remains the number one silent killer among infectious diseases in this country, and still places Indonesia as the country with the second-highest TB burden in the world after India, with an estimated 1,090,000 new cases per year according to the Global TB Report 2024.
If the medicine exists and is free, why do the deaths not stop? The answer lies not in the laboratory, but in our living rooms, in coffee shops, at office desks, and in our own heads: we are accustomed to hiding this disease, and it is the habit of hiding that cripples the nation.
Cases That Vanish in Silence
We should be suspicious when we see such a skewed figure. Ministry of Health data shows that, of the estimated 1,090,000 new TB cases per year, only around 885,000 cases were successfully found and reported in 2024. More than two hundred thousand people, in other words, were never recorded, never formally treated, and never counted. They are not statistical ghosts, but human beings who cough for months in narrow alleyways, shut themselves in their rooms, and ultimately die without a clear diagnosis.
Where do they disappear to? The answer is terribly simple and terribly human: shame. In many of our families, a TB diagnosis is still treated like a disgrace that must be buried. Neighbours are feared to keep their distance, prospective in-laws withdraw in an orderly fashion, employers look for excuses so that an employee whose illness is revealed slowly loses their place. A person who has been coughing up phlegm for more than two weeks, with afternoon fever, night sweats, and weight loss, would rather mix up cough medicine from a street stall than step into a community health centre. Not because they do not know where to seek treatment, but because they know exactly what the people around them will say.
Yet this choice of silence carries a very high price. TB is transmitted through the air; every month of delayed treatment is additional time for the bacteria to spread to homes, public transport, offices, and school classrooms. The stigma we have collectively built works precisely as the most efficient transmission machine. And when we measure it in rupiah, the damage it causes is truly extraordinary: the Minister of Health has noted that TB costs the national economy around Rp136.7 trillion per year, and around 70 percent of TB patients lose their jobs. Here lies the greatest irony: a curable disease instead cripples livelihoods, not because the bacteria are drug-resistant, but because society hides its sufferers.
The State Has Moved, the People Are Still Hiding
It would be unfair to direct criticism only at the government. The fact is, the state has moved. Through Presidential Regulation 67 of 2021, the TB control strategy includes strengthening commitment from central to regional levels, providing free medication, and reinforcing the role of communities. Regional governments are promoting the Find, Treat, Until Cured movement to remote areas, including in priority provinces with high case numbers. The instruments are complete: free medicine, clear guidelines, health workers ready to serve.
However, no matter how strong a policy is, it will become a beautiful document neatly stored away if citizens continue to choose to hide. TB elimination will never be achieved if it is entrusted only to lung specialists and community health centre staff. It requires a collective awareness that we still avoid. The community must become the first eyes to recognise symptoms in neighbours and relatives, become faithful Treatment Supporters accompanying patients through months of treatment, and become a community that welcomes with open arms those who have recovered, not a closed door for those who are ill.
The real test of the theme ‘Healthy Society, Strong Indonesia’ is not on the podium of officials, but at the family dinner table where parents dare to take their child to the health centre when a cough does not subside, in companies that do not sacrifice employees undergoing treatment, and in religious study groups that dare to make TB a subject of discussion rather than a taboo topic.
We also must not close our eyes to the aggravating factors of the outbreak that have been left unchecked. Indonesia has more than 61 million smokers, and findings from the Joint External Monitoring Mission show that 36 percent of TB cases in this country are linked to smoking. Smoking weakens the lungs, increases the risk of infection, and worsens the course of the disease. Even more painfully, Indonesia remains the only Asia-Pacific country that has not ratified the international framework for tobacco control. As long as mass smoking habits are left without serious control, TB elimination efforts will continue to be like bailing water from a leaking boat.
Ending the Era of Secrecy
Ending an outbreak does not begin with a vaccine or a laboratory; it begins with the courage to open one’s mouth. A prolonged cough must be treated as a health alarm that must be checked, not a family secret to be feared. Early diagnosis means shorter treatment, lower costs, and a far smaller chance of transmission. TB must be freed from its moral burden; TB patients are not a curse, but people who need support until they are fully cured.