Editorial: India has a long way to go in eradicating tuberculosis
India accounts for 26% of the world’s TB burden and 27% of global multi-drug resistant tuberculosis, which underscore the challenges facing the country’s National TB Elimination Programme
Malnutrition is the culprit in many diseases. Tuberculosis, an infectious disease caused by bacteria, is one of them. In a country like India, where undernutrition is rampant, particularly among children, eradicating tuberculosis continues to be a major challenge. The 2025 target set by the central government nearly a decade ago for the elimination of TB, appears a tall order, given the ground realities. The Global Tuberculosis Report by the World Health Organisation (WHO) shows that India accounts for 26% of the world’s TB burden and 27% of global multi-drug resistant tuberculosis. This grim statistic underscores the challenges facing the country’s National TB Elimination Programme, set against a backdrop of rising multidrug-resistant tuberculosis (MDR-TB), a public health crisis in its own right. Though the overall incidence of TB in the country decreased by 17.7%, from 237 cases per 1,00,000 population in 2015 to 195 per 1,00,000 in 2023 and the deaths reduced by 21.4%, from 28 per 1,00,000 population in 2015 to 22 per 1,00,000 in 2023, they fall short of the milestones set by the government for complete eradication of the disease. The healthcare authorities are grappling with multiple challenges. Grossly inadequate diagnostic facilities and delayed detection are the major areas of concern in the fight against the disease. Access to efficient and high-quality care — diagnosis, treatment and support — is still not available to patients. Erroneous prescription and dosage, poor quality of drugs and the discontinuation of medication regimens are some of the other key challenges.
Early diagnosis holds the key. The sooner treatment commences, the quicker the cycle of airborne transmission is halted. With under-investment in public health and the TB programme, the public sector is over-stretched. Because of the deficiencies in the public sector, nearly 80% of Indian TB patients choose to incur large out-of-pocket expenses and seek treatment with unregulated private practitioners. Some experts have suggested a multi-sectoral approach in the war against the disease. Poverty alleviation, improvement in nutritional status, well-ventilated housing and better air quality will all contribute towards reducing TB. Recent research has shown that nutritional supplementation reduced TB incidence substantially in household contacts of adults with microbiologically confirmed pulmonary TB. Infectious diseases like TB disproportionately affect the most marginalised in society, including children and the urban poor. It leads to an economic crisis which pushes families and communities into debt and poverty. The MDR-TB complicates the situation further, with India housing the largest global burden. It often arises from treatment mismanagement and requires longer, costlier and more toxic medications. Unfortunately, only 44% of the MDR-TB cases receive adequate treatment. This stark gap reveals the strain on India’s health infrastructure and the impact on patients whose access to quality care remains inconsistent. Moreover, funding for TB has dwindled in recent years. The government must bridge funding gaps and tackle the socioeconomic factors driving TB, including poverty and undernutrition.
