Tuberculosis remains one of India’s biggest public health challenges. The latest WHO report shows strong progress, but also highlights deep structural gaps that still hinder elimination efforts.

About Tuberculosis

• Historical Evidence: TB is an ancient disease, with evidence found in Egyptian mummies.
• Social Disease: TB is considered a social disease because it is linked not only to the Mycobacterium tuberculosis bacteria but also to poverty, malnutrition, and poor housing. 
  • Medical anthropologist Paul Farmer noted that TB “chooses the poor”.
• Mode of Transmission: TB spreads through the air when an infected person coughs or sneezes.
• Beyond the Lungs: TB is not exclusively a lung disease; it can be extra-pulmonary, affecting the brain, spine, or stomach. 

Key Findings Of WHO Global Tuberculosis Report 2025

• Decline in Incidence: India’s TB incidence rate fell by 21% from 237 per lakh in 2015 to 187 per lakh in 2024, the highest decline globally.
• Reduced Mortality: Deaths reduced from 28 per lakh in 2015 to 21 per lakh in 2024, saving millions of lives.
• High Treatment Success: Treatment success stands at 90% for new cases and 77% for drug-resistant cases.

Strategies Driving Success of Tuberculosis Treatment

• Advanced Technology: Molecular Diagnosis using the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) machine gives results in two hours and detects drug resistance. 
  • AI tools are used to scan X-rays and find cases missed by doctors.
• Nutritional Support: The Nikshay Poshan Yojana provides ₹500 per month to every TB patient to ensure nutritious food.
• Newer Therapies: A new treatment regime for Multi-Drug Resistant TB (MDR TB) called BPaL/M (a combination of drugs like Bedaquiline, Pretomanid, Linezolid, Moxifloxacin) was introduced. 
  • This new combination cures MDR TB in just six months using oral tablets, replacing the need for daily injections over two years, thereby improving patient adherence.

Challenges In the Treatment of Tuberculosis

• Highest Global Burden: India still accounts for 25% of the world’s TB cases and reported the most cases globally in 2024, maintaining its position as the world’s TB capital.
• Geographic Concentration: The highest numbers of TB cases are in Uttar Pradesh, Maharashtra, Bihar, and Madhya Pradesh. 
  • Delhi has the highest prevalence rate due to high population density, migration, and slums.
• MDR TB Threat: Multi-Drug Resistant TB is a major concern, as it resists the two most powerful medicines i.e Rifampicin and Isoniazid . 
  • India alone accounts for 32% of the world’s MDR TB cases in 2024.
• Missed Elimination Target: India set an ambitious target to eliminate TB by 2025 (ahead of the 2030 SDG target), but this goal has been missed.
• Insufficient Mortality Reduction: With TB mortality at 21 per lakh against a target of under seven, India still records nearly triple the deaths required to meet its elimination goal.

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Way Forward

• Decentralization of Diagnostics: Molecular diagnosis machines must be installed in Primary Health Care Centers (PHCs) in rural areas, as villagers currently often resort to unqualified doctors who prescribe antibiotics, leading to drug resistance.
• Addressing Social Determinants: Since TB is a disease of the poor, medical treatment must be coupled with addressing malnutrition and poor living conditions to boost immunity.
• Effective DOTS Implementation: The DOTS (Directly Observed Treatment Short-course) program must be effectively implemented to ensure patient compliance and prevent the development of MDR TB.
• Supply Chain Governance: Governance failures and drug shortages need to be addressed.
• Active Case Finding (ACF): Instead of passively waiting in hospitals, teams should be actively dispatched to high-risk areas to screen people who have been coughing for over two weeks.
• Private Sector Mandate: Since 50% of patients first consult private doctors, they should be compelled to notify every TB case on the Nikshay portal so the government can handle the situation.
• Scheme Linkage: The fight against TB could be linked to schemes like MNREGA to ensure workers receive food, nutrition, and screening.

Conclusion

India’s National TB Elimination Programme has delivered strong gains in diagnosis, treatment, and nutritional support. However, unless issues like MDR TB, poor living conditions, rural diagnostic gaps, and weak private-sector reporting are addressed, the goal of TB elimination will remain out of reach.

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