This is an archive article published on May 11, 2017

Study forecasts drug-resistant TB spike, spread person to person

1/8 of cases in India will be multi-drug-resistant by 2040, says Lancet paper on high-burden countries

4 min readPuneMay 11, 2017 02:42 AM IST

A study published online in the Lancet Infectious Disease journal has forecast an increase in drug-resistant tuberculosis cases in the four high-burden countries, including India, and suggested that person-to-person transmission will become the engine that drives drug-resistant tuberculosis in these countries.

By 2040, 12.4 per cent, or an eighth, of TB cases in India will be multi-drug-resistant, up from 7.9 per cent in 2000, says the study, by an international team of scientists. In the other three high-burden countries, multi-drug resistance will rise to 32.5 per cent of all cases in Russia, 8.9 per cent in the Philippines and 5.7 per cent in South Africa, respectively up from 24.8, 6 and 2.5 per cent in 2000.

Nearly 40 per cent of all drug-resistant TB cases occur in these four countries, accounting for more than 2,30,000 cases in 2015.

Globally, an estimated 10.4 million new cases of tuberculosis and 1.8 million deaths related to tuberculosis disease occurred that year. Multi-drug-resistant TB accounted for 480,000 cases, and 9.5% of these cases were estimated to be extremely drug resistant.

Of the multi-drug-resistant cases, one in 10 are expected to be extensively drug-resistant by 2040 — 9% in Russia and the Philippines, 8.9% in India, and 8.5% in South Africa — according to the study, based on a mathematical model using WHO data.

The study also estimates how many of these drug-resistant cases would be a result of non-resistant strains acquiring resistance during treatment. It predicts that fewer such cases will be caused by strains acquiring resistance — reducing from around 30% of cases of multi-drug-resistant tuberculosis in 2000 to 20-25% in 2040, and 80% of cases of extensively drug-resistant disease in 2000, to 50% in 2040.

Aditya Sharma of the US Centers for Disease Control and Prevention, said it isn’t enough to focus on curing people with TB or drug-resistant TB. “Even if we prevent new drug-resistant infections, there are enough current cases to keep the epidemic going. Drug-resistant TB will continue to be an increasingly dangerous threat so long as resistant strains spread through the air from one person to another,” PTI quoted Sharma as saying. “We must strengthen infection control measures, focus on households, health centres, and communities to prevent tuberculosis spreading from person to person, and develop more effective diagnostic tests to rapidly and accurately detect drug resistance.”

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According to health ministry figures, India has 2.8 million cases of TB every year. Of these, 2.8 per cent are new cases of multi-drug resistance while another 11.2 are acquired cases of multi-drug resistance, Dr Sunil Khaparde, deputy director general in the health ministry’s Central TB division, told The Indian Express.

Reacting to the findings of the study in The Lancet, Dr Zarir Udwadia, chest physician with Hinduja Hospital in Mumbai, told The Indian Express, “All over the world and India is no exception, MDR-TB is acquired upfront due to primary transmission. It is indeed frightening, for it tells us the epidemic has entered a new and accelerated phase… You get MDR or XDR-TB on day-one by being exposed to a large numbers of active infectious patients in the community. Prompt diagnosis and treatment of these infectious-index cases is the only way to reduce the spread.”

According to Dr Madhukar Pai, associate director of McGill International TB Centre, Canada, the modelling study shows that MDR- and XDR-TB will become more common in the four given the current treatment regimens and control methods.

“However for India, the model is simplistic because it ignores the huge proportion of TB that is managed in the private sector with suboptimal diagnostics, widespread antibiotic abuse, and limited capacity to ensure adherence among TB patients. So, unless something is done about improving quality of TB care in the private sector, the situation for India might be worse than what is predicted by this modelling study,” Pai said.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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