The hurdles in India’s fight to eliminate TB

November 17, 2025
Current Affairs

Indian Express

1. Introduction and Context

This editorial critically examines India’s progress and persistent gaps in its battle against tuberculosis (TB), drawing upon findings from the WHO Global TB Report 2025. Despite improvements in diagnostics, notifications, and the adoption of modern treatment regimens, India remains off-track to meet its self-declared TB elimination target of 2025.

The article highlights structural challenges in:

Diagnosis and early detection
Treatment coverage and adherence
Infrastructure and human resources
Drug-resistant TB management
Recovery after COVID-19 disruptions

These issues make TB a major public health, social, and economic concern for India.

2. Key Arguments Presented

a. India remains the world’s highest TB burden country

Key WHO estimates for 2023:

2.7 million TB cases (up from 2.42 million in 2022)
3.1 lakh deaths
India accounts for 27% of global TB cases

The author notes that the burden remains staggering, despite several improvements.

b. India’s TB elimination target (2025) is unlikely to be met

WHO projects that India may meet TB elimination goals closer to 2035–2040, not 2025.

Reasons:

COVID-19 disruptions
Underdetection and underreporting
Treatment interruptions
Persistent malnutrition and poverty
Inadequate adoption of global best practices

c. Diagnosis and treatment coverage remain inadequate

Concerns raised:

Only 63% of estimated cases were on treatment in 2023
Large diagnostic gaps in rural, tribal, and hard-to-reach areas
Delayed testing → higher severity & transmission
Over-reliance on private sector services with variable quality
Weak last-mile access to molecular diagnostics such as CBNAAT, TrueNat

d. Drug-Resistant TB (DR-TB) is a major and growing threat

Issues include:

Rising MDR-TB and RR-TB incidence
Poor adherence and treatment interruptions
Lengthy, toxic, and costly regimens
Higher disability and mortality

The editorial warns that DR-TB could derail national elimination efforts entirely.

e. Innovations exist, but scaling remains slow

Promising developments:

Shorter regimens (BPaL, BPaLM)
Digital tools (99DOTS, Nikshay) for adherence
Expanded molecular testing

However:

Limited coverage in low-resource regions
Funding constraints
Human resource shortages at PHCs
Digital monitoring not universally accessible

3. Author’s Stance

The stance is critical, data-driven, and reform-oriented.

The author:

Recognises gains in technology and notification
Highlights serious structural gaps
Emphasises that the pace of progress is insufficient

Tone: Urgent yet balanced, calling for comprehensive strengthening rather than incremental improvements.

4. Bias and Limitations

Bias

Overemphasis on failures; limited credit to flagship initiatives (Ni-kshay Poshan Yojana, expansion of CBNAAT labs, community participation models)
WHO estimates used without including the Indian government’s counterarguments

Limitations

Insufficient discussion on social determinants (housing, sanitation, air pollution)
No comparison with successful global TB-control models
No state-level analysis (Tamil Nadu, Kerala, Himachal Pradesh are performing better)

5. Pros and Cons of the Argument

Pros

Strong evidence base from WHO
Highlights structural weaknesses in the NTEP
Emphasises DR-TB—an often overlooked crisis
Recognises role of private sector challenges

Cons

Oversimplifies TB complexity in a population of 1.4+ billion
Underplays improvements in nutritional support and digitisation
Ignores stigma, migration, and informal labour constraints
Lacks regional success narratives

6. Policy Implications

a. Strengthen primary healthcare systems

Increase availability of CBNAAT/TrueNat machines
Continuous training for health workers
Expand active case-finding

b. Strong focus on Drug-Resistant TB

Universal DST (Drug Susceptibility Testing)
Make shorter MDR regimens widely accessible
Strengthened monitoring and follow-up

c. Improve treatment adherence

Expand digital adherence tools
Strengthen Ni-kshay Poshan Yojana (nutrition support)
Community volunteers for vulnerable groups

d. Enhance public–private collaboration

Mandatory notification compliance
Training for private practitioners
Incentives for standardised TB care

e. Address social determinants

Focus on migrants, slum dwellers, miners, tribal populations
Improve nutrition, ventilation, sanitation
Expand social protection nets

7. Real-World Impact

If gaps persist:

Higher fatality rates
Rapid rise in MDR-TB
Increased economic burden (TB causes major productivity loss)
India losing momentum toward SDG goals

If reforms accelerate:

Faster TB incidence decline
Improved public trust in healthcare
Reduced catastrophic health expenditure
India back on track toward elimination by 2035

8. Alignment with UPSC GS Papers

GS Paper II

Public health systems
NTEP, Ni-kshay, TB elimination strategies
Centre–state coordination in health

GS Paper III

Disease epidemiology
Drug resistance and biotechnology
SDG 3 (Health)
Health financing and primary care

GS Paper I

Social determinants: poverty, migration, urbanisation

Essay

Public health crises
Disease elimination challenges
Human development and governance

9. Conclusion and Future Perspectives

The editorial presents a compelling and evidence-backed analysis of why India is struggling to achieve TB elimination, despite technological advances and strong policy intent. Delays in diagnosis, inadequate treatment adherence, the rise of drug-resistant TB, and weakened health systems post-COVID pose serious challenges.

A balanced path forward requires:

Universal, high-quality diagnostics
Public health infrastructure strengthening
Rapid rollout of new DR-TB regimens
Nutritional and socioeconomic support
Stronger public–private collaboration
Continuous digital monitoring and data-driven strategies

India can accelerate its TB elimination journey—but only with sustained investment, robust governance, and community-centered health systems.