# Infectious disease transmission pressure

## What this driver is

Infectious-disease transmission pressure is the continuing intensity of person-to-person (and vector) spread of pathogens that already have control programmes — tuberculosis as the disclosed World Bank meter, with influenza, measles, and novel respiratory viruses as neighbouring channels. It is not [COVID-19 pandemic](/drivers/covid-19-pandemic), not [mpox outbreaks](/drivers/mpox-outbreaks), and not [Ebola outbreak response](/drivers/ebola-outbreak-response). Those are event or architecture bundles. This node is the standing transmission pressure.

It is not [pandemic preparedness](/drivers/pandemic-preparedness) (capacity) and not [vaccine accessibility](/drivers/vaccine-accessibility). Transmission can rise while preparedness scores sit still.

The meter is World Bank WLD SH.TBS.INCD (TB incidence per 100,000) divided by 200: 0.725 (2016), 0.670 (2019), 0.655 (2020), 0.670 (2023). COVID-era disruption flattened then reversed TB declines — a named WHO observation. This page does not invent a unique TB case total.

## Mechanism

Transmission moves welfare through named channels.

First, contact rate. Crowding, displacement, and clinic closure raise effective contacts. COVID lockdowns cut some respiratory spread and interrupted TB diagnosis in the same years. Those are different signed channels. This page does not net them into a unique coefficient.

First-order: untreated infectious people. TB treatment interruption in 2020 is the dated WHO/Global Fund neighbourhood. Measles missed doses sit on [vaccine hesitancy](/drivers/vaccine-hesitancy-wave) and [immunization investment](/drivers/ph-immunization-investment).

Second, novel pathogens. COVID-19 and mpox are stored as their own drivers. This node does not absorb them.

Third, antimicrobial failure. [Antimicrobial resistance](/drivers/antimicrobial-resistance) makes the same transmission more lethal. Neighbouring, not a twin.

Fourth, the TB meter. Incidence 145 (2016) → 134 (2019) → 131 (2020) → 134 (2022–23) per 100,000. A 2020 dip in *reported* incidence can be a detection failure, not a biological victory. WHO has warned about that. The meter is disclosed, not smoothed.

Timing is days for a respiratory generation interval and years for TB. A later WHO Global TB Report point would be a new data row.

## Evidence base

World Bank SH.TBS.INCD (https://api.worldbank.org/v2/country/WLD/indicator/SH.TBS.INCD?format=json&date=2016:2023&per_page=30), underlying WHO Global TB Programme. WHO Global TB Reports 2021–2024 named the COVID detection gap.

Evidence is strongest for an official incidence point. It is weaker for any unique “missed TB diagnoses 2020” integer. It is weakest where a 2020 incidence dip is asked to prove transmission fell.

## Effect on welfare indicators

- [Under-five mortality rate](/indicators/ph-under-five-mortality-global): direction higher deaths when measles and paediatric TB/respiratory waves run. Horizon: same years. Confidence: medium. Lower-is-better.
- [Life expectancy at birth](/indicators/health-welfare-021-life-expectancy-at-birth): direction lower LE when adult TB and respiratory mortality rise. Horizon: years. Confidence: medium.

## Interactions and contested points

Transmission interacts with pandemic preparedness, COVID-19 pandemic, antimicrobial resistance, and [health-system capacity](/drivers/health-system-capacity). Reinforcement is obvious when a clinic gap and a missed-dose cohort hit the same district. Offsetting is the claim that COVID lockdowns permanently lowered TB. The 2022–23 rebound argues otherwise.

The strongest competing view is that a TB meter cannot carry “infectious-disease transmission.” TB is the densest official global incidence series. Novel events have their own drivers.

Established: TB incidence 145 (2016) → 134 (2023) per 100,000; COVID-era detection warning. Not established: a unique Factrail case total. A later WHO point would be a new fact.

WHO Global TB Report 2022–24 named a backlog of missed diagnoses after 2020 clinic interruption and a rebound in reported incidence. Those reports are the edge instruments for the 131 (2020) dip. Influenza and measles waves remain neighbouring official series (WUENIC; FluNet). They are not copied onto this TB meter. Mpox and Ebola keep their own PHEIC instruments.

WHO and World Bank series used on this driver are official published points. They are transformed only by the disclosed divisor in the catalog. Contested modelled totals (excess deaths, DALYs, dollars pledged) remain named edge instruments. Affiliates without a public-complete people.xml dossier stay plain text. The WHO Director-General is not minted. Pipeline V2, autocreate, and modules/news stay off. Person.score is not written. Ukraine-war, nagorno-karabakh-war, and eastern-drc-m23-rdf are not reminted. [Territorial-revisionism](/drivers/territorial-revisionism) (1918–45) is not this health node.

Live Facts already attached to companion health drivers (WHO pandemic characterization, PHEIC end, COVAX Accra, US WHO-withdrawal notices) stay on those Facts. Articles explain; news does not mint people. A later official series year is a new data point when the provider publishes it. Missing years stay missing. Correlation between a global average and a district outcome is not causation.

## Dated facts

- 2025: Mass food-poisoning clusters hit students on Prabowo’s free-meals programme. https://factrail.ai/facts/id-prabowo-mbg-poisoning-2025. Sources: https://www.reuters.com/business/healthcare-pharmaceuticals/over-800-indonesian-students-suffer-mass-food-poisoning-government-free-meals-2025-09-19/, https://www.setneg.go.id/.
- 2022: The Gates Foundation commits $1.2 billion to polio eradication. https://factrail.ai/facts/gates-polio-2022. Sources: https://www.pbs.org/newshour/amp/health/gates-foundation-pledges-1-2b-to-eradicate-polio-heres-why-its-been-a-struggle-for-decades, https://www.gatesfoundation.org/ideas/media-center/press-releases/2022/10/world-health-summit-gates-foundation-commits-over-one-billion-to-end-polio.
- A 2022 COVID wave hits after the earlier low-case spell. https://factrail.ai/facts/tw-tsai-covid-2022. Sources: https://www.reuters.com/world/asia-pacific/taiwan-covid-wave-omicron-2022-05-01/, https://www.cdc.gov.tw/.
- 2021: WHO recommends RTS,S malaria vaccine after foundation-backed trials. https://factrail.ai/facts/gates-malaria-rts-2021. Sources: https://www.reuters.com/world/who-malaria-vaccine-rts-s-2021-10-06/, https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk.
- 2021: Venezuela begins COVID-19 vaccine imports with Sputnik V, later adding COVAX batches. https://factrail.ai/facts/ve-vaccines-2021. Sources: https://www.reuters.com/article/us-health-coronavirus-venezuela-idUSKBN2AD0N1, https://www.paho.org/en/news/29-april-2021-venezuela-receives-first-batch-covid-19-vaccines-through-covax-facility-support.
- 2020: Pakistan creates the National Command and Operation Centre for COVID-19. https://factrail.ai/facts/pk-imran-ncoc-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-pakistan-idUSKBN21E0K4, https://covid.gov.pk/.
- 2020: Cabinet places New Zealand at COVID-19 Alert Level 4, a nationwide stay-at-home order. https://factrail.ai/facts/nz-covid-alert-level-4-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-newzealand-idUSKBN21A0Y20200323, https://www.health.govt.nz/covid-19-novel-coronavirus.
- 2020: Greece imposes an early nationwide COVID lockdown. https://factrail.ai/facts/gr-covid-first-wave-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-greece-idUSKBN21A1G4/, https://www.primeminister.gr/en.
- 2020: Myanmar confirms COVID-19 and Suu Kyi’s government issues controls. https://factrail.ai/facts/mm-suu-covid-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-myanmar-idUSKBN21A0K4, https://www.mohs.gov.mm/.
- 2020: Google makes Meet free and scales Workspace during COVID closures. https://factrail.ai/facts/goog-workspace-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-google-meet-idUSKBN2130K4, https://blog.google/.
- 2020: Apple closes retail stores for COVID-19 then reopens with health protocols. https://factrail.ai/facts/aapl-covid-retail-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-apple-idUSKBN2110K4, https://www.apple.com/newsroom/.
- Taiwan’s early COVID response keeps cases low through 2020–21. https://factrail.ai/facts/tw-tsai-covid-2020. Sources: https://www.reuters.com/article/us-health-coronavirus-taiwan-idUSKBN20Y0K4, https://www.cdc.gov.tw/.

## Methodology

https://factrail.ai/methodology

Canonical: https://factrail.ai/drivers/infectious-disease-transmission