Why hasn’t India met its target of eliminating TB by 2025?

India diagnosed the highest ever 26.18 lakh cases in 2024, further closing the gap between the estimated number of cases and the ones actually diagnosed. There were only around one lakh “mission cases”. This is significant considering that people who miss out on a diagnosis under the programme continue to spread the infection further.

India was among the eight high-burden countries that were able to diagnose more than 80% of the estimated cases last year. However, with the highest burden of TB cases, India was among the top countries contributing towards the global gap. The country accounted for 8.8% of the global gap, which was behind only Indonesia, which accounted for 10% of the global gap between estimated and diagnosed cases.

Reaching the END TB targets

In 2018, Prime Minister Narendra Modi announced India’s ambitious target of eliminating TB by 2025, five years ahead of the global target. Although there has been a consistent decline in the estimated number of TB cases — as well as the rate of TB cases per 100,000 population — India is nowhere close to its target of eliminating the bacterial disease by 2025.

Note that while elimination is defined as less than one case per million population, the WHO End TB strategy targets an easier 80% decline in new TB cases and 90% decline in TB deaths by 2030 as compared to the baseline year of 2015.

The Global TB Report 2025 shows that India has achieved only a 21% reduction in new cases and a 28% reduction in deaths between 2015 and 2024. This does not even come close to the End TB milestones for 2025 — a 50% reduction in TB incidence and 75% reduction in TB deaths. In fact, it essentially means that India in 2024 was able to meet only half of the global milestones set for 2020 — reducing TB cases by 20% and deaths by 35% as compared to 2015.

But this reduction achieved by India is ahead of the global average. TB incidence reduced only by 12% between 2015 and 2024 across the world.

Dr S K Kabra, former professor of paediatric pulmonology at AIIMS, New Delhi, said: “There is a need to introspect and see whether the targets were realistic. If they were, there is a need to take a look at where we stand and what the reasons are for us not reaching the targets. There has to be a programme to consult all stakeholders, such as the patients, their family members, the labs, DOT (Directly Observed Treatment Short Course) centres, doctors, nurses, regulators, everybody, to look for gaps and address them.”

Diagnosis and treatment coverage

The Global TB Report shows significant improvement in India’s treatment coverage, which stood at 92% in 2024, increasing from 85% in 2023. “India’s innovative case finding approach, driven by the swift uptake of newer technologies, decentralisation of services and large-scale community mobilisation, has led to the country’s treatment coverage to surge to over 92% in 2024 from 53% in 2015,” the Union Health Ministry said in a statement.

The expansion of treatment coverage came due to initiatives such as the BPaL regimen, which can cut the treatment time for resistant infections to six months from a previous 18 to 24 months.

However, Kabra says certain gaps remain. “There has been significant progress, such as the introduction of all oral treatment for multidrug-resistant TB, but preparations for childhood TB are still not very readily available. The government also provides TB preventive treatment to household contacts and other people at risk of the infection, which is also not very readily available. But these are small targets in the big picture towards elimination,” he said.

Another expert, on condition of anonymity, told The Indian Express that there were also challenges with the availability of the more common drugs in parts of the country in 2024.

Drug-resistant risk factors

India also continues to be a big contributor towards drug-resistant TB, accounting for nearly a third of the global cases. While the burden of such resistant infections has not reduced, it has not increased significantly either. In 2024, 12.63% of those previously treated for TB and 3.64% of the new cases were drug-resistant in India. This increased from 12.5% and 3.53% the previous year, according to the new report. This translates to around 1.27 lakh people with drug-resistant TB in 2024, up from 1.26 lakh in 2023 and 1.24 lakh in 2024.

The report also shows that the success rate of TB treatment — for those who initiated their treatment in 2023 — stood at 90%. The Union Health Ministry said that this was ahead of the global success rate of 88%.

Dr Jugal Kishore, head of community medicine at Safdarjung Hospital, said: “There are several things that set back India’s fight against TB. The most important being the Covid-19 pandemic, when resources were diverted from the programme for its management. Completion of treatment is another challenge — people sometimes stop treatment midway, which can result in drug-resistant infections, which are then transmitted by them in the community,” he said.

He added that in cities such as Delhi, air pollution further worsens the outcome for TB patients.

Pollution, along with diseases such as diabetes that are on the rise, also increases the risk of TB in people, he said. In 2024, an estimated 3.2 lakh TB cases could be attributed to diabetes.

Innovations in the programme

In addition to shorter courses of treatment, such as BPaL, the government has also introduced other innovations, such as AI-enabled hand-held X-ray devices that can detect even asymptomatic TB cases during community screening. This was used during the 100-day campaign launched by the government in December last year, with many of the measures introduced after the 100 days in areas other than the high-risk districts.

During these active screening campaigns beginning last year, more than 19 crore vulnerable individuals have been screened for TB under the campaign, resulting in a detection of over 24.5 lakh cases, including 8.61 lakh asymptomatic cases.

“This proactive approach draws on both global and local evidence underscoring the prevalence of asymptomatic TB in high-burden settings,” the Union Health Ministry said in its statement.