Reference Article: Editorial | The Hindu – Swing, but do not miss: on India and the WHO’s Global Tuberculosis Report 2025
UPSC Relevance:
– GS Paper II: Health, Governance, and Social Justice
– GS Paper III: Science and Technology, Inclusive Development
The World Health Organization’s Global Tuberculosis Report 2025 presents a mixed picture for India. While India recorded the steepest decline in TB incidence globally — a 21% drop from 237 to 187 per lakh population between 2015 and 2024 — it continues to bear the largest TB burden in the world, accounting for 25% of global cases.
Current Situation and Statistics
- India registered the highest number of TB cases in 2024, with Uttar Pradesh, Maharashtra, Bihar, and Madhya Pradesh contributing the most.
- Delhi has the highest prevalence rate of infection, though absolute numbers remain smaller.
- India also recorded the highest global burden of multidrug-resistant (MDR) and rifampicin-resistant (RR) TB, comprising 32% of global cases.
- Treatment success rates: 90% for new and relapse cases; 77% for MDR-/RR-TB patients under second-line treatment.
- Mortality rate: declined from 28 to 21 deaths per lakh between 2015 and 2024 — an improvement, but still over three times higher than India’s elimination target.
Analysis: Progress and Persistent Gaps
- India’s TB elimination target of 2025 — five years ahead of the global goal — remains unmet.
- Incremental progress has saved millions of lives, but gaps in diagnosis, treatment continuity, and socio-economic support persist.
- The challenge is particularly acute for MDR-TB, which requires prolonged, expensive treatment and suffers from frequent drug shortages and treatment default.
- Rural and marginalised populations continue to face barriers to timely diagnosis and sustained care, worsened by malnutrition and poverty, both key risk factors for TB infection.
Key Drivers of Progress
- Technological innovations: Adoption of AI-based screening, molecular diagnostics, and rapid drug resistance detection tools.
- Nutrition support schemes: The government’s Ni-Kshay Poshan Yojana and other nutritional interventions have helped reduce vulnerability among high-risk groups.
- Drug-resistant TB management: Introduction of BPaLM therapy (bedaquiline, pretomanid, linezolid, moxifloxacin) for resistant cases.
- Integrated surveillance and community engagement: Enhanced reporting through Ni-Kshay portal and partnerships with private healthcare providers have improved monitoring and data accuracy.
Challenges Ahead
- Diagnosis gap: Many cases remain undetected, particularly in remote and rural regions.
- Socio-economic inequities: Poverty, poor housing, and malnutrition remain systemic barriers.
- Drug availability: Irregular supply and high costs of second-line drugs threaten continuity of treatment.
- MDR-TB crisis: The growing resistant strain poses both a medical and logistical challenge to elimination efforts.
- Public awareness and stigma: Social barriers continue to deter timely testing and treatment.
Way Forward
- Strengthen community-based detection systems and expand access to rapid molecular diagnostics across all districts.
- Ensure uninterrupted drug supply chains and wider rollout of newer treatment regimens.
- Integrate TB elimination efforts with broader nutrition and poverty alleviation schemes.
- Boost research and innovation funding for TB vaccines, faster diagnostics, and drug-resistant strain monitoring.
- Promote inter-sectoral coordination between health, welfare, and rural development ministries to tackle the socio-economic determinants of TB.
Conclusion
India’s fight against tuberculosis has made measurable progress but still falls short of its ambitious 2025 elimination goal. The decline in incidence and mortality signals resilience and policy momentum, yet persistent gaps in diagnosis, resistance management, and nutrition threaten long-term success. A sustained, multi-pronged approach — combining technology, social policy, and robust healthcare delivery — is crucial to transforming India’s TB story from gradual improvement to total eradication.
UPSC Practice Question:
India’s progress in TB elimination is commendable but insufficient to meet its 2025 goal. Critically analyse the factors driving progress and the persistent challenges in eliminating tuberculosis.