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Ending Workplace TB is committed to supporting our members to improving the health, productivity, and resilience of their workforces. Our work is based on the best-available research and we want to make sure that all partners have access to that research. Below you will find the papers that back up the things we say - as well as other useful resources.


Headline: Research suggests that even one case of TB could result in up to 50% of the workforce being infected.

TB can spread quickly in settings with prolonged contact, limited ventilation, and a high population density: i.e, many workplaces. This means if even one colleague falls sick, many others may be at risk.

To illustrate this point, we have identified three studies which show that TB can spread dramatically in workplaces. The 50% figure is drawn from two separate studies in Taiwan and the United States. The third study relates to an investigation of a single workplace in Australia where the proportion of co-workers infected was slightly lower, but still significant.

Workplace contact investigations in the United States. Davidow et al (2003).

A Tuberculosis Outbreak at a Workplace in Central Taiwan, 2016, Hsing-Yi Wang et al (2018) 

Transmission of tuberculosis infection in a commercial office, Bagherirad et al (2014)


Headline: Relatively simple, low-cost interventions have been found to reduce the spread of respiratory diseases in the workplace by 99%.

The research that underpins this claim is drawn from studies of seasonal flu. Whilst this may seem to be remote from TB, flu is much more infectious than TB and the symptoms manifest more quickly. As such, it is probable that measures that are effective for reducing the attack rate of flu in a workplace will be even more effective for TB. 

The study explored several combinations of sick leave policy to find which would have the greatest benefit for the health of the workers. It found that a scenario where 90% of sick workers took sick leave almost as soon as symptoms appeared almost eliminated workplace spread of the disease. Given other research (see above and below) about the volume of cases of respiratory diseases that start in the workplace, the potential impact for a community of eliminating workplace transmission could be significant.

Evaluating costs and health consequences of sick leave strategies against pandemic and seasonal influenza in Norway using a dynamic model - Edwards et al (2019)


Headline: People who are ill with TB often lose a high number of days of work before they are diagnosed and sick people can be as much as 20% less productive.

This statement comprises two different groups of facts: the number of days of work lost by people who are sick with TB (absenteeism) and the productivity of people who are ill (presenteeism). This is a problem both before and after diagnosis - and especially profound for workers who get paid for piece-work, who may find their income dropping off long before they realise that they are ill.

Of the many studies relating to time lost from work due to TB, we present a couple here - please contact us if you wish for more details.

Time lost to work

Socio-economic impact of TB on patients and family in India. Rajeswari et al (1999)

Barriers to tuberculosis control in urban Zambia: the economic impact and burden on patients prior to diagnosis. Needham et al (1998)

Productivity losses due to ill health

The impact of HIV/AIDS on labour productivity in Kenya. Fox et al (2004)

Impacts and Determinants of Health Levels in Low-Income Countries. Dupas et al (2016)

Management and Shocks to Worker Productivity: Evidence from Air Pollution Exposure in an Indian Garment Factory, Adhvaryu et al (2014)


Headline: TB is a lethal respiratory pathogen and shares many symptoms and testing procedures with COVID-19. A strong workplace health system can help protect your workforce from the impact of diseases.

There are two assertions in this statement. The former relates to the similarities between TB and COVID-19, though there are also similarities between TB and other lethal respiratory pathogens. The latter relates to the impact that a strong workplace health system can have on your workforce in the face of a respiratory pathogen.

The overlap between TB and COVID-19 has so far manifested itself in the wholesale transfer of TB resources to tackle the COVID-19 pandemic (see here). However, TB and COVID-19 also share five common core symptoms: headache, cough, muscle aches, fatigue and loss of appetite. They can also both be screened for with X-rays (as can flu) and are both diagnosed using a polymerase chain reaction (PCR) such as the GeneXpert system.


As such, systems and structures that identify the symptoms of TB infection, as well as making TB screening and testing available to everyone, will pick up cases of other respiratory diseases - and through separating sick workers from healthy ones and initiating treatment, the chain of transmission can be broken. As up to 50 per cent of COVID-19 cases are spread in the workplace in some areas, the beneficial impact of a workplace health system is clear.

Work-related COVID transmission. Fan-Yun et al 2020


Headline: Research suggests that comprehensive workplace health systems yield a net positive return on investment for companies.

Although EWTB expressly targets workers who stand the most to benefit from not being at risk of TB or other respiratory diseases at work, the benefits for employers are also significant (see more on the next page)

Putting a precise figure on the ROI is hard as it varies so much on the health of your workforce. Malaria programmes have been found to yield a 28% ROI (see below). One company in unpublished data estimates that their HIV/TB programme has yielded a net positive impact of USD$15 per employee. And yet further research has found a positive ROI for HIV programmes in both the public and private sectors.

Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa. Roll Back Malaria (2011)

The cost of HIV/AIDS to businesses in southern Africa. Rosen et al (2004)

The Impact of AIDS on Government Service Delivery: The Case of the Zambia Wildlife Authority. Rosen et al (2006)

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