fight-against-tuberculosis-far-from-over

India’s battle against tuberculosis presents a paradox: on one hand, there is substantial progress in reducing the incidence, but on the other hand, the country still accounts for the highest disease burden in the world. 

 

The latest annual Global TB report by the World Health Organisation (WHO) illustrates this paradox. With over 27 lakh TB cases recorded last year, India accounts for the highest disease rate in the world at 25 per cent, followed by Indonesia (10 per cent), the Philippines (6.8 per cent), China (6.5 per cent), Pakistan (6.3 per cent), and Nigeria (4.8 per cent).

 

However, the silver lining is that the country achieved a 21per cent reduction in the incidence of the disease in the last decade—from 237 per lakh population in 2015 to 187 per lakh population in 2024—and a 28per cent decline in TB deaths during the same period. This is almost double the rate of decline observed globally. Notwithstanding this improvement, the figure is still over three times higher than the government’s elimination target.

 

The WHO report, released last week, noted that the treatment coverage had increased to 92per cent, placing India ahead of other high-burden countries.

 

Elusive goal

 

Despite making significant progress in reducing the number of tuberculosis cases, India still falls short of the goal of completely eliminating the bacterial disease by the end of 2025. 

 

In 2020, the government renamed the Revised National Tuberculosis Control Programme (RNTCP) as the National TB Elimination Programme (NTEP) and set 2025 as the target for total elimination of the disease. However, the goal has been missed, and the disease continues to impact many, posing serious health, social, and economic challenges. Within the country, Uttar Pradesh has the highest number of cases, followed by Maharashtra, Bihar and Madhya Pradesh. While these States have the highest burden in terms of case numbers, Delhi has the highest TB infection prevalence rate.

 

There are critical gaps in the NTEP that need to be fixed to make the country free from the dreaded bacterial disease. Challenges are many, but the country has the wherewithal to achieve the goal. A weak healthcare infrastructure, especially in rural areas, and socio-economic disparities affect access to diagnosis and treatment. Other key challenges include supply chain disruptions, a shortage of trained personnel, and social stigma attached to the disease. 

 

Also read: Not pneumonia or TB, heart diseases and stroke kill more Indians

 

The growing number of drug-resistant TB cases in the country is another area of concern. India recorded the highest number of multidrug-resistant TB cases in 2024 — accounting for 32per cent of global MDR-TB- and rifampicin-resistant (RR-TB) cases. Unfortunately, only 44per cent of the MDR-TB cases receive adequate treatment. Increasing public awareness about MDR-TB and expanding the use of newer treatment regimens could be game-changers.

 

Laudable initiatives

 

It must be said to the credit of the healthcare authorities and dedicated workers that India has achieved credible progress in its efforts to check the tuberculosis menace.

 

The central government has aggressively worked towards TB elimination, starting with extensive screening of vulnerable individuals and setting up the largest TB laboratory network in the world, comprising 9,391 rapid molecular testing facilities and 107 culture and drug susceptibility testing laboratories.

 

The community screening efforts have been enhanced by over 500 Artificial Intelligence-enabled hand-held chest X-ray units available across the country. Through 1.78 lakh Ayushman Arogya Mandirs, the programme has been able to decentralise services and take TB care closer to communities.

 

The Union Health Ministry has also expanded nutritional support provided to TB patients. The Direct Benefit Transfer (DBT) under the Nikshay Poshan Yojana (NPY) was increased from Rs 500 to Rs 1,000 per month per patient for the entire treatment duration. ASHA workers have been trained to identify early warning signs in TB patients in their areas and refer them to better treatment facilities.

 

Tackle malnutrition

 

Malnutrition is the culprit in many diseases. Tuberculosis, an infectious disease caused by bacteria, is one of them. In a country like India, where undernutrition is rampant, particularly among children, eradicating Tuberculosis continues to be a major challenge. The costs of treating and managing TB still prove burdensome for many households in India.

 

Poverty and malnutrition are responsible for up to 40 per cent of the incidence in the country. A good diet not only reduces the incidence of the disease among vulnerable people living with infected people, but it also brings down mortality in TB patients.

 

Unequal access to economic opportunities, limited health care, poor sanitation, crowded living conditions, malnutrition and illnesses such as diabetes or HIV are all associated with increased risk of tuberculosis.

 

Access to efficient and high-quality care — diagnosis, treatment and support — is still not available to patients. Erroneous prescription and dosage, poor quality of drugs, and the discontinuation of medication regimens are some of the other key challenges.

 

Early diagnosis holds the key. The sooner treatment commences, the quicker the cycle of airborne transmission is halted. With under-investment in public health and the TB programme, the public sector is overstretched. Because of the deficiencies in the public sector, nearly 80per cent of Indian TB patients choose to incur large out-of-pocket expenses and seek treatment with unregulated private practitioners.

 

Multi-sectoral approach

 

Some experts have suggested a multi-sectoral approach in the war against the disease. Poverty alleviation, improvement in nutritional status, well-ventilated housing and better air quality will all contribute towards reducing TB.

 

Recent research has shown that nutritional supplementation reduced TB incidence substantially in household contacts of adults with microbiologically confirmed pulmonary TB. Infectious diseases like TB disproportionately affect the most marginalised in society, including children and the urban poor. It leads to an economic crisis, which pushes families and communities into debt and poverty.

 

This stark gap reveals the strain on India’s health infrastructure and the impact on patients whose access to quality care remains inconsistent.

 

The government must bridge funding gaps and tackle the socio-economic factors driving TB, including poverty, undernutrition and limited healthcare access.

 

Without robust investment and coordinated efforts, TB will continue to thwart India’s health goals and global ambitions.

 

There is fresh evidence linking pollution to the worsening of the TB condition among patients, and the disruption of their immune system makes diabetics more vulnerable to the bacterial disease.  The healthcare authorities must factor this environmental threat into the anti-TB strategies to make them more effective.