India & TB Report 2025

Why in News?

The WHO Global Tuberculosis Report 2025 presents a mixed assessment of India’s TB control efforts—showing the fastest global decline in TB incidence, yet confirming that India continues to bear the largest TB and drug-resistant TB burden worldwide.

Background & Context

Tuberculosis remains one of the most persistent public health challenges globally and in India. While the global target for TB elimination is 2030, India adopted an ambitious national goal of eliminating TB by 2025. The 2025 WHO report evaluates India’s progress as substantial but insufficient to meet this accelerated timeline, underlining the need for renewed policy focus and implementation strength.

What is Tuberculosis (TB)?

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis.

Transmission

• Spread through airborne droplets when an infected person coughs, sneezes, or speaks.

Types

• Pulmonary TB: Affects lungs (most common)
• Extra-pulmonary TB: Affects lymph nodes, bones, brain, kidneys
• MDR-TB: Resistant to first-line drugs
• RR-TB: Resistant to rifampicin

Causes & Risk Factors of TB

• Weak immunity (HIV, diabetes, malnutrition)
• Poor living conditions and overcrowding
• Smoking and alcohol use
• Delayed diagnosis and incomplete treatment

Common Symptoms of TB

• Persistent cough (>2 weeks)
• Fever and night sweats
• Weight loss and loss of appetite
• Fatigue
• Chest pain and blood in sputum (advanced cases)

Key Highlights from WHO Global Tuberculosis Report 2025

1. TB Incidence and National Burden

• India recorded a 21% decline in TB incidence—from 237 per lakh population (2015) to 187 per lakh (2024), the highest decline globally.
• Despite this, India accounts for 25% of the global TB burden, making it the largest contributor to worldwide TB cases.
• State-wise distribution:
  • Highest absolute cases: Uttar Pradesh, followed by Maharashtra, Bihar, Madhya Pradesh
  • Highest prevalence rate: Delhi, despite lower absolute numbers

2. Drug-Resistant TB: A Persistent Weak Spot

• India recorded the highest number of drug-resistant TB cases globally in 2024.
• 32% of global MDR-TB and rifampicin-resistant TB cases originate from India.
• Treatment success rates:
  • New and previously treated TB cases: ~90%
  • MDR/RR-TB cases: ~77% (on second-line treatment)
• This gap highlights the complexity, cost, and long duration of MDR-TB treatment.

3. Mortality Trends

• TB mortality declined from 28 deaths per lakh (2015) to 21 per lakh (2024).
• However, mortality remains more than three times higher than India’s TB elimination target, signalling unfinished public health gaps.

Why India Missed the 2025 Elimination Target

• TB elimination requires sustained reductions over decades, not incremental gains.
• Although millions of lives have been saved, progress has been uneven across regions and populations.
• Structural challenges continue to limit the pace of decline.

Factors Driving India’s TB Progress

• Advanced diagnostics: Molecular tests, AI-based screening, rapid drug-resistance detection
• Improved treatment: Introduction of newer regimens such as BPaLM for drug-resistant TB
• Nutrition support: Targeted schemes to address undernutrition among vulnerable populations
• Focused MDR-TB strategies: Dedicated protocols and drug access under NTEP

Persistent Challenges Identified

• Diagnostic gaps, especially in rural and remote areas
• High MDR/RR-TB burden, with lower treatment success
• Frequent drug shortages and supply chain issues
• Malnutrition, a key driver of TB incidence and poor outcomes
• Socio-economic inequalities, including overcrowding, poverty, and migration

Way Forward

• Strengthen primary healthcare diagnostics, particularly in rural India
• Integrate TB control with nutrition, sanitation, and poverty alleviation programmes
• Ensure uninterrupted drug availability and patient follow-up
• Scale up MDR-TB specific care and shorter regimens
• Address social determinants through community-based interventions