In 2018, when India set the ambitious goal of eliminating tuberculosis by the year 2025 (five years ahead of the global target), it was seen as a necessary move. The country accounted for more than a quarter of the world's TB burden, and if any nation needed an accelerated response, it was India. Yet, despite notable progress, TB remains deeply entrenched in the country’s healthcare landscape. We are past the deadline, and the battle is far from won. The government now speaks of 2047 as a more realistic target. So, what went wrong?

The Paradox of Progress:

But TB control is not just about identifying and treating patients. The disease thrives in the country’s deep-rooted inequalities: poverty, malnutrition, overcrowding, and limited healthcare access. These structural challenges have proven far more difficult to overcome.

On paper, India has made tremendous strides in the fight against TB. The number of notified TB cases increased from 15 lakh in 2014 to 26 lakh in 2023, reflecting significant improvements in case detection and reporting, as highlighted in the India TB Report 2024. Access to free treatment through the National TB Elimination Program (NTEP) has expanded, and new diagnostic tools have made early detection more efficient.

Roadblocks to a TB-Free India:

 Treatment Gaps and Poor Adherence:

Even when diagnosed, patients struggle with completing the six-month-long treatment regimen. Side effects, lack of awareness, and financial constraints often cause patients to drop out midway, leading to relapses and the rise of multi drug-resistant TB (MDR-TB). “Strengthening primary health care and preventive strategies would enable more effective last-mile delivery of medicines,” says Dr. Sujit Paul, Group CEO of Zota Healthcare Ltd. He believes that integrating technology, nutrition support, and active patient engagement is essential for progress.

Delayed Diagnosis and Drug-Resistant TB:

Early detection is crucial, yet many patients experience delays in diagnosis, allowing the infection to spread. Many cases remain undiagnosed in rural areas, where healthcare infrastructure is weak, and awareness is low. Compounding this issue is drug-resistant TB, which does not respond to standard treatments. Dr. Sameer Bhati, Director of Star Imaging and Path Lab Ltd., says, “Certain types of TB bacteria are resistant to even the most common medicines, which makes treatment more complicated and lengthy.”

The Role of Nutrition

Undernutrition is one of the biggest risk factors for TB. Malnourished individuals are more likely to contract the disease and less likely to recover fully. A study by India Tuberculosis Research Consortium and ICMR found that providing food rations and micronutrient supplements to TB patients led to better treatment success, significant weight gain, and a reduction in mortality rates.

 One of the most striking findings was that a 5% weight gain within the first two months of treatment reduced the risk of death by 60%. Even more significantly, nutritional supplementation reduced TB incidence among household contacts by 40-50%. Says Dr. Dhananjay Singh, Executive Director at Sanmat, who was part of the team, “Addressing undernutrition is not just an add-on to TB care, it is central to stopping transmission and improving patient outcomes.”

Social Stigma and Economic Barriers:

TB continues to carry a stigma that discourages people from seeking timely medical help. Many fear social exclusion, leading them to hide their symptoms and avoid treatment. For daily wage workers, a TB diagnosis often means financial ruin, as they are unable to work while undergoing treatment. Dr. Bhati stresses the need for “a joint effort where healthcare professionals, communities, and government come together to eradicate TB.”

What Needs to Change?

1. Stronger Focus on Nutrition:

The RATIONS trial underscores the importance of nutrition in TB prevention and treatment. “Providing food security to vulnerable populations should be a priority. Food rations, protein supplements, and conditional cash transfers for TB patients could be game-changers,” says Dr. Dhananjay Singh

2. Digital Health Solutions:

Technology can bridge the gap between patients and healthcare providers. Mobile-based treatment adherence programs, AI-driven diagnostics, and telemedicine can improve early detection and patient follow-ups. Pharma companies like DavaIndia are working toward affordable healthcare solutions, ensuring essential medicines are accessible.

3. Aggressive Screening and Preventive Treatment:

Instead of waiting for symptomatic patients to approach hospitals, India needs widespread active case-finding initiatives. Household contact screening and preventive treatment for those at risk (including malnourished children) should be ramped up.

4. Shifting the Narrative from Treatment to Prevention:

India’s TB strategy has long been reactive: identifying and treating cases after they emerge. A true elimination strategy should prioritize breaking the transmission cycle through vaccination, improved living conditions, and widespread education campaigns.

India’s battle against TB is a classic case of ambitious goal-setting meeting systemic barriers. While progress has been made, the 2025 goal was always an uphill battle. With the government now eyeing 2047 for TB elimination, the next two decades must not repeat the mistakes of the last. India can lead the global fight against TB, but only if it addresses the root causes of the disease: malnutrition, poverty, stigma, and healthcare inequities.

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