India’s Fight Against TB

India is working hard towards its ambitious goal to eliminate TB by 2025, by far the world’s most ambitious health mission. Ending the TB epidemic by 2030 is also the health target set by the United Nations Sustainable Development Goals (SDGs).

TB is a contagious airborne disease caused by Mycobacterium tuberculosis and mainly affects the lungs, but can also impact other body parts. It spreads when an individual coughs, sneezes or spits, releasing infectious droplets. TB is the world’s leading cause of death from a single infection agent and the leading killer of people with HIV.

India’s efforts against TB

India accounts for 27% of all global TB cases, the highest TB burden in the world. In 2022, India reported 199 cases per 100,000 population. Of the total TB cases reported globally, 87% of them were reported from 30 high-burden countries like Bangladesh, China, DR Congo, India, Indonesia, Nigeria, Pakistan and the Philippines.

To tackle this significant burden, India is implementing a range of focused strategies. Under the National Tuberculosis Elimination Programme (NTEP), India has strengthened its TB response with advanced diagnostics, innovative policies, private sector partnerships, and a patient-first approach. The NTEP focuses on four key actions: Detect, Treat, Prevent and Build (DTPB). These efforts have led to TB cases decline from 237 per lakh in 2015 to 195 per lakh in 2023. India is also working towards increasing drug-resistant TB treatments like mBPaL regimen (Bedaquiline, Pretomanid, Linezolid), which offers 80% success for multidrug-resistant tuberculosis (MDR-TB), cutting treatment to six months.

The Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA), a major component of NTEP, focuses on providing nutritional, diagnostic, vocational support, treatment outcomes, and reduce illness and deaths. It is recognised as the world’s largest crowd-sourcing initiative for nutritional support to TB patients. Under this, the Ni-Kshay Mitra initiative encourages individuals, NGOs, corporates, faith-based organisations, and others to adopt TB patients for at least six months, offering them nutritional, social, or economic support. The Ni-kshay Portal also helps keep track of a number of different numbers related to TB and its treatment.     

Launched in 2018, the NIKSHAY – TB Notification Incentive for the Private Sector is an important program to integrate private players into the TB surveillance and treatment ecosystem. 

The major challenge

According to the WHO Global TB Report, 2024, India has made significant progress in fighting the disease, but a lot still remains to be achieved.  While India continues to work on its policies and improve ground-level service delivery, the biggest challenge to meet its 2025 target comes from declining global TB funding. In 2023, only 26% of the US$ 22 billion annually needed for TB prevention and care was available, leaving a massive shortfall. The 2025 funding cuts further exacerbate an already underfunded global TB response. India also faces a significant burden of MDR-TB due to inadequate treatment adherence, inappropriate drug prescriptions and poor quality of medications. There is also a systemic lack of awareness when it comes to TB and taking precautionary measures against it, especially when contrasted with heightened public awareness seen during the CVOID-19 pandemic.

Compared to research in Oncology, there is also insufficient research and funding related to TB, which impacts innovation and suboptimal access to services. This is also because TB is largely linked to poverty and sees more occurrence in third-world countries, making it a very low priority for developed nations. TB is a complex problem that extends to patient’s nutrition, compliance, human resources, as well as social issues, making the fight against it more difficult. Hence, dealing with TB requires comprehensive solutions that strengthen the complete chain and does not just focus on a single regimen.