Abstract:
Introduction: Tuberculosis (TB) remains a major global health concern, particularly in low-income countries
where the impact is greater. The lack of proper surveillance tools in these countries is a big impediment to
effective TB control. Whole-genome sequencing (WGS) has successfully been integrated into routine TB programs
in high-income countries and transformed disease surveillance by providing rapid, high-resolution transmission
insights, drug resistance profiling, and outbreak detection. However, its uptake in resource-limited settings
where TB burden is most prevalent remains limited.
Methods: This review examines how WGS is currently being utilised for TB surveillance and highlights the main
obstacles to its adoption in limited-resource settings as well as the strategies that could improve its uptake. A
literature search was conducted in PubMed, Google Scholar, and the World Health Organisation (WHO) databases with keywords "whole genome sequencing," "tuberculosis," "surveillance," "transmission," and "drug
resistance." Studies published between 2015 and 2025 were prioritised, with a focus on applications in highburden settings.
Results: Key challenges identified include infrastructural issues whereby 78% of high-burden countries lack
adequate sequencing facilities according to WHO 2023 data; financial barriers, with recurring costs surpassing
$150 per sample in low-resource settings as compared to $80 in high-income countries, and a shortage of trained
personnel with only 2.3 bioinformaticians being available per African country. Other hurdles involve concerns
over data sovereignty, weak regulatory frameworks, and ethical dilemmas surrounding privacy and equitable
data usage, with only 31% of low-resource countries having genomic data policies. Nevertheless, promising
innovations like portable sequencing devices which have a sensitivity of up to 92% and cloud-based platforms
that reduce computational needs by 70% offer scalable opportunities for equitable integration. We also highlight
partnership models that blend WHO technical guidance, Global Fund financing, and South-South collaborations
that could enhance sustainability.
Conclusion: To realise the full potential of WGS in TB-endemic regions, a coordinated approach that combines
technical advancements with policy changes, ethical data governance, and sustained investment is needed.
Tackling these challenges is essential in achieving equitable, genomics-informed TB control that aligns with
global TB elimination goals.
