Inching there

India’s 17.7% reduction in tuberculosis (TB) incidence between 2015 and 2023—double the global average of 8.3%—is commendable. The National TB Elimination Program (NTEP) has played a significant role in this success. However, the ambitious target of reducing TB incidence to just 10 cases per 100,000 people by 2025 remains a distant dream. With India still accounting for 30% of the global TB burden and a staggering 62% of multidrug-resistant TB (MDR-TB) cases alongside Russia and China, the challenge is far from over.

The high disease burden is rooted in systemic failures—poor healthcare infrastructure, inadequate awareness, and widespread malnutrition. TB thrives in vulnerable populations, particularly among those with compromised immune systems. Despite government interventions, millions remain undiagnosed or receive delayed treatment due to stigma and lack of access to quality healthcare. Pulmonary TB is widely recognized, but extrapulmonary TB—where the infection spreads beyond the lungs—often goes undetected, exacerbating the crisis.

While initiatives like the 100-Day TB Elimination Campaign and expanded diagnostics through Ayushman Aarogya Mandirs are steps in the right direction, they are insufficient given the scale of the epidemic. Community engagement is crucial to dispel myths, reduce stigma, and ensure that TB patients receive necessary support. Additionally, India must drastically improve its healthcare workforce and diagnostic capabilities. Early detection remains critical, yet the country’s surveillance and screening mechanisms are inadequate, especially in rural areas. Strengthening the network of accredited laboratories for reliable testing is imperative.

Investing in research and innovation is another crucial aspect. Advances such as rapid molecular tests (e.g., Xpert MTB/RIF) and shorter, less toxic drug regimens have improved outcomes, but MDR-TB and extensively drug-resistant TB (XDR-TB) continue to pose grave threats. The development of host-directed therapies and new vaccines holds promise but requires sustained funding and commitment. Without substantial public and private investment in TB research, India’s elimination target will remain unattainable.

One of the biggest hurdles is patient adherence to treatment. The long duration of TB therapy—ranging from six months to two years—leads to high dropout rates, increasing drug resistance. Strengthening follow-up mechanisms and providing financial and nutritional support to patients can help ensure treatment completion. Furthermore, integrating telemedicine into TB care can enhance accessibility, particularly in remote regions where healthcare services are scarce.

While the government’s intent is clear, intent alone cannot eliminate TB. A multi-pronged approach—bolstering healthcare infrastructure, increasing awareness, fostering research, and ensuring socio-economic support—is needed. The 2025 target may be unrealistic at this pace, but with sustained, strategic interventions, India can move closer to a TB-free future.