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A new World Health Organization (WHO) report has once again placed India at the top of the global tuberculosis (TB) burden chart, in terms of incidence of all TB cases, drug-resistant types of TB, and even TB- deaths. The Global Tuberculosis Report 2025 states that India, despite seeing a drastic drop in incidence rates since 2010, still accounted for 25 per cent of all TB cases, 32 per cent of drug-resistant variants of TB cases, and about 28 per cent of TB- deaths in 2024.  

This comes despite India’s ambitious goal to eliminate TB by 2025, five years ahead of the United Nations’ global target of 2030. With only months left for this deadline we set ourselves in 2018, when India had vowed to reduce TB incidence by 80 per cent and mortality by 90 per cent from 2015 levels by this deadline, it is important to revisit the causes behind this surge and what we can do to arrest its progress.  

What is the scale of tuberculosis cases according to the new report?

Tuberculosis (TB) is “one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent,” claiming over 12 lakh lives and affecting over 1 crore people in 2024, according to WHO.

Eight countries accounted for two-thirds of the incident cases in 2024.  

This included India, which continued to lead globally, accounting for 1 in every 4 of such incident cases in 2024. Indonesia came a distant second, with 10 per cent of the global cases. The other high-burden countries were Philippines (6.8 per cent), China (6.5 per cent), Pakistan (6.3 per cent), Nigeria (4.8 per cent), the Democratic Republic of the Congo (3.9 per cent) and Bangladesh (3.6 per cent).

India also bore the brunt of the TB- deaths as well– with the country accounting for 28 per cent of all TB- deaths among HIV negative people, and 25 per cent of such deaths among those who were diagnosed HIV positive. This is despite India seeing a 28 per cent reduction in TB deaths overall between 2015 and 2024.  

The latest report also brings cautious optimism, highlighting that in recent years the number of people falling ill with TB and dying of the condition had seen a fall.  

“Globally, the absolute number of people falling ill with TB decreased in 2024 for the first time since 2020, following three consecutive years of increases (2021–2023) due to COVID- disruptions to TB diagnosis and treatment. The total of 10.7 million was a small (1 pc) reduction from 10.8 million in 2023, but still above the level of 2020 (10.3 million),” it said, adding that between 2023 and 2024, the global rate of people falling ill with TB declined further by nearly 2 per cent. 

“The estimated global number of deaths caused by TB fell for a third consecutive year in 2024, continuing the reversal of increases that occurred during the worst period of COVID- disruptions to TB diagnosis and treatment in 2020 and 2021,” it said, adding that in the last year, it had fallen by 3 per cent.  

However, these are far behind the goals set by the international body to eliminate the disease by 2030. “The net reduction from 2015 to 2024 (in incident cases) was 12 pc, far from the ‘End TB Strategy’ milestone of a 50 pc reduction by 2025 and the target of an 80 pc reduction by 2030,” it said. The number of deaths had also fallen by 29 per cent between 2015 and 2024, but again much below the target of  “a 75 pc reduction by 2025” and “a 90 pc reduction by 2030.”

How does variants of TB that are resistant to drugs make the crisis worse? 

Drug-resistant varieties of the disease also make progress particularly difficult. The WHO Global TB Report 2025 notes that “drug-resistant TB continues to be a public health threat. Resistance to rifampicin – the most effective first-line anti-TB drug – is of greatest concern.”  

When TB bacteria become resistant to both rifampicin and isoniazid, it is classified as multidrug-resistant TB (MDR-TB). Four countries accounted for more than half of global MDR/RR-TB (rifampicin-resistant TB) cases in 2024—India (32 per cent), China (7.1 per cent), the Philippines (7.1 per cent), and the Russian Federation (6.7 per cent).

What are India’s biggest challenges when it comes to TB?

In March 2018, at the “End TB Summit” held in New Delhi, Prime Minister Narendra Modi announced India’s intent to eliminate TB by 2025—five years ahead of the global target. Since then, India has made measurable progress as the TB incidence rates fell from 237 per lakh population in 2015 to 195 per lakh in 2023, marking a 17.7 per cent decline.

However, progress has plateaued in recent years. Union Minister of State for Health and Family Welfare, Anupriya Patel, said in March 2025 that India reported 25.5 lakh TB cases in 2023 and 26.07 lakh in 2024, the highest ever notified. According to the government, this increase reflects that they are “missing” fewer cases now due to a more comprehensive screening and detection process, rather than a resurgence of the disease.  

Among the most pressing concerns in India’s TB fight is drug-resistant tuberculosis (DR-TB). India’s first anti-TB drug resistance survey (2018) revealed that one in four new TB patients was resistant to at least one of 13 key treatment drugs. This poses a serious threat to treatment outcomes. “Upfront NAAT testing identifies resistance at diagnosis, allowing tailored treatment,” Niraj Sinha, state lead, TB Alert India, told First Check earlier. 

However, Dr Tanvi Bhatt, Pulmonologist at Zynova Shalby Hospital, Mumbai, explained that one of the main reasons for the rise in drug-resistant tuberculosis is the use of empiric anti-TB treatment without proper microbiological confirmation. She noted that in many private healthcare settings, affordability and diagnostic challenges, especially when TB affects hard-to-sample sites, often prevent accurate detection. 

“This can lead to delayed diagnosis, where patients are treated as drug-sensitive cases while underlying drug-resistant TB goes unrecognised,” Dr Bhatt said. She emphasised the importance of testing all family members of drug-resistant TB patients, explaining that “if this is not done, there is a high risk that other family members may contract drug-resistant tuberculosis over time.” 

The BPALM regimen, a six-month treatment for DR-TB, has reduced therapy duration from two years, significantly improving patient outcomes. However, non-compliance in the private sector worsens resistance. 

“Universal drug sensitivity testing costs Rs 2,000– Rs 5,000 in the private sector, so many patients skip it,” he said, adding that the Nikshay portal plays a crucial role in tracking resistance patterns and adherence. 

Despite technological advancements, India hasn’t conducted a new resistance survey since 2018, leaving critical gaps in understanding the current landscape. Social stigma and treatment fatigue further complicate the issue. “Patients often stop treatment after one or two months when symptoms improve, risking relapse and resistance,” Sinha added. 

Former WHO Chief Scientist Dr Soumya Swaminathan has also voiced skepticism about the feasibility of complete elimination without a new vaccine. “No infectious disease has been eliminated without one,” she said, speaking to First Check earlier this year, noting that the BCG vaccine, developed over a century ago, offers only partial protection, mainly against severe childhood TB, and provides little defence against adult pulmonary TB, which drives most transmission. 

What are the other major reasons behind India’s continued struggles with TB?

In February 2025, the government told Parliament that while procurement systems have improved to ensure uninterrupted medicine supplies, reliance on smear microscopy, an outdated diagnostic technique, remains high. The India TB Report 2024 revealed that in 2024, only 26.2 per cent of tests used modern NAAT (Nucleic Acid Amplification Test), with most facilities still depending on conventional methods. 

Dr Bhatt highlighted that social and health factors also contribute to the overall surge in TB cases.  While TB care is free under the National TB Elimination Programme (NTEP), a 2024 study found that 45 pc of TB-affected households faced catastrophic costs, exceeding 20 per cent of their annual income. The study attributed about two-thirds of this financial strain to indirect costs such as lost productivity, travel, and nutritional expenses rather than treatment fees.

Most TB patients in India belong to the unorganised workforce, which lacks social protection such as paid leave, health insurance, or job security. As a result, many are forced into lower-paying jobs after prolonged illness. The same study reported that only 55.9 per cent of TB survivors remained employed, and just 33.6 pc were primary earners, highlighting how the disease deepens economic vulnerability. 

Poor nutrition, poverty, and overcrowded living conditions increase susceptibility, while chronic illnesses such as diabetes, HIV, and lung problems further raise the risk.  Dr Bhatt added that “lifestyle factors including smoking and alcohol use, weaken the lungs and reduce immunity.” Dr Bhatt also pointed out that “lack of awareness, social stigma, and fear of losing employment often cause people to delay testing or discontinue treatment, which facilitates further spread in the community.”  

What is India’s plan to eliminate TB?

According to a recent government press release, the Government of India has implemented a range of focused strategies under its National Tuberculosis Elimination Programme (NTEP), according to a recent government press release. These initiatives aim to strengthen diagnosis, treatment, and prevention efforts, accelerating progress toward a TB-free India. 

In 2020, the government renamed the Revised National Tuberculosis Control Program (RNTCP) as the National TB Elimination Programme, reflecting India’s goal to eliminate TB by 2025, five years ahead of the global target. The NTEP operates under the National Strategic Plan (2017–2025) and focuses on four key actions: Detect, Treat, Prevent, and Build (DTPB) to control and ultimately eliminate TB in the country. 

One of the key components of the programme is the Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA). The press release states that the initiative “aims to unite communities, businesses, and institutions to support TB patients and their families,” focusing on nutritional, diagnostic, and vocational support to improve treatment outcomes, reduce illness and deaths, and fast-track India’s TB elimination goal. PMTBMBA is also recognised as the world’s largest crowd-sourcing initiative for nutritional support to TB patients. 

The Nikshay TB notification incentive for the private sector, launched in 2018 by the Ministry of Health and Family Welfare, incentivises private healthcare providers to report TB cases, improving both surveillance and treatment coverage. Nutritional support for patients has also been expanded under the Ni-Kshay Poshan Yojana (NPY).

The press release notes that financial support has increased from Rs 500 to Rs 1,000 per month, providing Rs 3,000 to Rs 6,000 per patient throughout treatment, provided the patient is registered and notified on the Nikshay portal. To further strengthen recovery, the government has introduced Energy Dense Nutritional Supplementation (EDNS) for underweight TB patients with a body mass index below 18.5. Around 12 lakh patients are expected to receive these supplements during the first two months of treatment, improving overall health outcomes. 

The Ni-Kshay Mitra initiative, another component of PMTBMBA, encourages individuals, NGOs, corporates, and faith-based organisations to adopt TB patients for at least six months, providing nutritional, social, or economic support. The scope of this initiative has been expanded to include food baskets for household contacts of TB patients, aiming to boost immunity, reduce infection risk, and lower the financial burden on families. 

What are the gaps in the national plan to eliminate TB?

Dr Bhatt said that while the government’s TB programme has made significant progress, several challenges still remain. She explained that “many patients first visit private doctors, where proper TB tests and reporting are not always done. Early testing for drug resistance is still not available everywhere, especially in smaller towns and villages.”  

She also pointed out that some areas face delays in medicine supply or a shortage of trained staff. “The financial and nutrition support provided to patients is often insufficient or delayed, which affects their ability to complete treatment,” Dr Bhatt added. She emphasised that better coordination and stronger ground-level work are needed to make the programme more effective. 

Regarding healthcare-level interventions, Dr Bhatt stressed that “all patients should get quick and reliable TB testing, including tests for drug resistance, right from the start. Hospitals and clinics must ensure that medicines are always available and that patients receive proper counselling to complete their treatment.” 

On the community level, she highlighted the importance of awareness and support. “There should be more campaigns to educate people about TB symptoms, testing, and treatment. Support for nutrition and income can help patients stay on treatment. Involving local health workers, using digital tools like reminder calls or messages, and strengthening public-private partnerships can also help reduce TB spread and prevent drug resistance,” Dr Bhatt said. 

This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.