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Introduction

The WHO Global Tuberculosis Report 2025 presents a mixed picture for India, an impressive decline in incidence yet persistently high burdens of cases and drug resistance. As India inches toward its ambitious TB elimination goal, these findings expose deep challenges that demand sharper strategies and stronger systems.

Findings of the WHO Global Tuberculosis Report 2025

• Significant Decline in TB Incidence: India recorded the world’s highest decline in TB incidence, 21% reduction since 2015.
  Eg: Incidence dropped from 237/lakh (2015) to 187/lakh (2024).
• India Still Bears the Largest Global TB Burden: Despite improvements, India accounts for 25% of global TB cases.
  Eg: India recorded the maximum TB cases globally in 2024.
• High Burden of MDR-/RR-TB: Drug-resistant TB continues to be a major threat.
  Eg: India accounts for 32% of global MDR-/RR-TB cases, the highest worldwide.
• Mixed Treatment Outcomes: While treatment success is strong in general TB, it is poorer for MDR-TB.
  Eg: 90% success for new cases vs 77% success for MDR-/RR-TB cases.
• Declining Mortality But Still Far From Targets: Mortality dropped but remains much higher than elimination goals.
  Eg: TB deaths fell from 28/lakh (2015) to 21/lakh (2024), still three times higher than government targets.

Major Challenges Impeding India’s TB Control Efforts

• Missed Elimination Deadline: India aimed to eliminate TB by 2025, 5 years before the global target but has fallen short.
  Eg: High incidence, mortality, and MDR rates show insufficient progress.
• Diagnosis Gaps, Especially in Rural Areas: Many cases remain undetected due to limited diagnostic access.
  Eg: Shortage of molecular detection tools and screening infrastructure in rural districts.
• Rising Socio-Economic Vulnerabilities: Poverty, poor nutrition, and overcrowding heighten susceptibility.
  Eg: Malnutrition remains a major driver in tribal and low-income regions.
• High Burden of Drug-Resistant TB: MDR-/RR-TB requires longer, complex treatment and often leads to poor outcomes.
  Eg: India’s 32% global share of MDR cases strains public health systems.
• Frequent Drug Shortages & Treatment Interruptions: Unreliable supply chains delay treatment initiation and affect adherence.
  Eg: Periodic stockouts of second-line drugs undermine MDR-TB management.

Way Forward

• Expand Rapid Diagnostics & Rural Access: Scale molecular testing, AI-enabled screening, and digital case tracking.
  Eg: Deploy TrueNAT/CBNAAT devices in all PHCs and mobile vans in remote areas.
• Strengthen MDR-/RR-TB Management: Ensure timely detection, uninterrupted drug supply, and access to new regimens.
  Eg: Wider rollout of BPaLM and other newer therapies across high-burden districts.
• Address Socio-Economic Determinants: Improve nutrition, housing, and cash support for TB patients.
  Eg: Expand nutritional schemes similar to Nikshay Poshan Yojana, with better fund flow.
• Improve Supply Chain & Drug Availability: Build resilient procurement and buffer stock systems for all TB drugs.
  Eg: A central digital dashboard for real-time drug stock monitoring.
• Strengthen Community Engagement & Private Sector Collaboration: Encourage awareness, early reporting, and private provider notification.
  Eg: Incentivise private clinics for prompt testing and mandatory reporting under NTEP.

Conclusion

India’s progress against TB is undeniable, but the persistent burden, diagnostic gaps, and rising drug resistance reveal how far the elimination dream still is. Only through resilient systems, stronger community outreach, and sustained socio-economic support can India convert its mixed trajectory into a decisive victory against TB.

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