WHY INDIA WILL MISS TUBERCULOSIS ELIMINATION TARGET BY 2025

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Context

India aimed to eliminate TB by 2025, five years before the global Sustainable Development Goal (SDG)  target of 2030. Despite progress, India will miss this deadline.

What is Tuberculosis (TB)?

It is a contagious disease caused by a type of bacteria called Mycobacterium tuberculosis. 

Spread: TB germs spread through the air when a person with active lung or throat TB coughs, or speaks. It is not spread by casual contact like shaking hands or sharing utensils.

Symptoms: Cough (lasting three weeks or longer), chest pain, coughing up blood or sputum, weakness or fatigue, weight loss, fever, chills, and night sweats.

Treatment: TB is curable, but treatment requires multiple antibiotics for 4-6 months or longer to kill all bacteria and prevent drug resistance.

India's TB Burden & Progress 

India, despite having the highest global TB burden, has shown faster-than-average reductions in both TB incidence and mortality worldwide.

Uttar Pradesh has the highest number of TB cases, followed by Maharashtra, Bihar, and Madhya Pradesh.

In India, treatment coverage increased to over 92% in 2024, from 53% in 2015 — with 26.18 lakh TB patients being diagnosed in 2024, out of an estimated incidence of 27 lakh cases.  (Source: WHO Global TB Report 2024)

Government Interventions

India's strategy is guided by the National Strategic Plan for TB Elimination (2017-2025) under the National TB Elimination Programme (NTEP).

Pradhan Mantri TB Mukt Bharat Abhiyaan: A community support initiative where individuals and organizations can adopt TB patients as 'Ni-kshay Mitras' to provide nutritional, diagnostic, and vocational support.  

• Treatment success rate under the TB Mukt Bharat Abhiyan increases to 90%, ahead of the global treatment success rate of 88%. (Source: Union Health Ministry)

Active Case Finding (ACF): Proactive screening campaigns in vulnerable populations using tools like AI-enabled handheld X-ray devices to find and treat "missing" cases early.

• Over 19 crore vulnerable individuals have been screened, leading to the diagnosis of 24.5 lakh TB patients, including 8.61 lakh asymptomatic cases.  (Source: Union Health Ministry)
• More than 500 AI-enabled handheld X-ray units are already deployed nationwide, with another 1,500 being delivered to states and union territories. (Source: Union Health Ministry)
• TB care has been decentralised through 1.78 lakh Ayushman Arogya Mandirs, enabling early diagnosis and treatment closer to communities. (Source: Union Health Ministry)

Ni-kshay Poshan Yojana: Under the Yojana, the monthly nutritional support for TB patients has been doubled from Rs 500 to Rs 1,000 per month.  

• Ni-kshay Mitras: 6.7 lakh Ni-kshay Mitras (individuals and organisations) distributing over 45 lakh food baskets to TB patients. (Source: Union Health Ministry)
• Universal Drug Susceptibility Testing (UDST): Provision of rapid molecular diagnostics to all diagnosed TB patients to test for drug resistance at the outset. 
• Shorter Treatment Regimens: Rollout of newer, shorter, and more effective drug regimens for both drug-sensitive and drug-resistant TB to improve treatment adherence and outcomes.

Why India Is Missing the 2025 Target?

Despite progress, structural, social, and systemic hurdles hinder India's path to TB elimination. The reasons are complex and interconnected.

Challenge of Drug-Resistant TB (DR-TB)

• High Burden: India accounts for over 25% of the world's drug-resistant TB cases (Source: WHO). 
• Complex Treatment: DR-TB treatment is lengthy, costly, and causes severe side effects, resulting in high patient dropout, which increases resistance and community spread.
• Implementation Gaps: Widespread, equitable availability of newer, shorter, all-oral regimens like BPaL/BPaLM remains a challenge.

Vicious Cycle of Malnutrition and TB

• A Key Driver: Malnutrition weakens the immune system, making individuals more susceptible to TB. Conversely, TB worsens malnutrition. Undernutrition is a primary driver of the TB epidemic in India.
• Evidence from RATIONS Trial: A 2023 Lancet study in Jharkhand, the RATIONS trial, proved that providing food baskets to TB patients and their families reduced TB mortality by nearly 60%, highlighting intensive nutritional support as life-saving intervention.

Healthcare System Gaps and Weaknesses

• Diagnostic Delays:  Limited, uneven distribution of testing centers in remote areas causes delays in diagnosis and treatment.
• Human Resource Shortages: A lack of trained doctors, lab technicians, and community health workers (ASHAs) affects the quality of care, active case finding, and patient support.
• A 2024 CAG report on Bihar revealed a 58% vacancy in doctor posts as per WHO norms, and 32% below the national average.  
• Funding Constraints: Funding gaps hinder the National TB Elimination Programme (NTEP), affecting the availability of drugs, diagnostics, and essential resources.
• Private Sector Engagement: Many TB patients initially use the private sector. Despite mandatory notification, under-reporting hampers accurate surveillance and care coordination.

 Social and Economic Determinants

• Poverty and Living Conditions: Overcrowded, poorly ventilated, and unsanitary urban slums facilitate the airborne spread of TB.
• Stigma and Lack of Awareness: TB-related social stigma causes delayed care, non-disclosure, and poor treatment adherence.
• Co-morbidities: Rising rates of diseases like diabetes and silicosis increase TB risk. Air pollution also worsens treatment outcomes.

Impact of the COVID-19 Pandemic

The pandemic diverted resources and personnel, disrupting TB services. Lockdowns caused a sharp drop in TB notifications in 2020 and 2021, reversing gains by creating a large pool of undiagnosed cases.

Way Forward 

Adopt a Multi-Sectoral Approach

Integrate TB control with ministries responsible for nutrition (food security), housing (better living conditions), and social justice to address the social determinants of the disease.

Strengthen Nutritional Support

Scale up evidence-based nutritional interventions like the RATIONS trial model and make it an integral, non-negotiable part of TB care.

Enhance Private Sector Engagement

Create robust mechanisms with a mix of incentives, regulations, and technology (via the Ni-kshay portal) to ensure every private provider notifies and provides standard care for TB patients.

Focus on Prevention

Scale up TB Preventive Treatment (TPT) for high-risk groups, such as household contacts of TB patients and people living with HIV, to break the chain of transmission.

Invest in Research & Innovation

Increase Investment in the R&D of new vaccines, point-of-care diagnostics, and more effective, shorter drug regimens.

Strengthen Primary Healthcare

Strengthen primary healthcare infrastructure and human resources, especially in rural and tribal areas, to ensure last-mile delivery of TB services.

Conclusion

Though India missed the 2025 TB elimination goal, the effort built essential infrastructure and political momentum. A TB-free future requires a sustained, multi-sectoral strategy addressing social determinants like poverty and malnutrition.

Source: INDIAN EXPRESS