India’s War on TB : Innovation, inclusion, and the road to elimination

Dipak Kurmi
Tuberculosis (TB), long regarded as one of the world’s deadliest infectious diseases, is facing an unprecedented counter offensive in India. As the country shoulders the highest global TB burden, its fight against this ancient scourge is drawing global attention not merely because of its scale but for its approach — defined by political will, community engagement, scientific innovation, and a data-driven public health model. At the helm of this effort is Prime Minister Narendra Modi, whose recent review of the National Tuberculosis Elimination Programme (NTEP) reaffirms India’s resolve to eliminate TB by 2025 — five years ahead of the global Sustainable Development Goal target.
The timing of the Prime Minister’s renewed emphasis on the TB mission is critical. Advances in diagnostics, digital tools, and candidate vaccines are opening new frontiers in TB control. His call to scale up successful and innovative strategies, anchored in public participation, coincides with global momentum, as highlighted in the World Health Organization’s Global TB Report 2024. The report offers cautious optimism : between 2015 and 2023, global TB incidence declined by 8.3%. India, remarkably, achieved a 17.7% reduction — more than double the global rate. These gains testify to the efficacy and reach of the NTEP, which has transitioned from passive detection to proactive elimination.
Yet, despite this progress, major challenges remain— foremost among them is the diagnostic gap. In 2023 alone, an estimated 2.7 million people worldwide developed TB but were neither diagnosed nor notified. Without diagnosis, treatment is impossible, and the chain of transmission remains unbroken. India’s own epidemiological burden, though declining, continues to be undermined by these so-called “missing millions.” More worrying is the emerging evidence that a significant proportion of these cases are subclinical — individuals who carry the TB infection without manifesting any symptoms. In high-burden settings like India, studies suggest subclinical TB may constitute nearly 50% of total infections, fueling a silent but potent transmission cycle.
The 100-day intensified TB-Mukt Bharat Abhiyaan, recently concluded, was a crucial experiment in addressing this invisible threat. Unlike conventional screening methods that rely primarily on symptomatic detection, this campaign adopted a more inclusive strategy by targeting vulnerable populations regardless of symptom presence. The results were revealing and instructive : out of 7.19 lakh cases diagnosed, 2.85 lakh were asymptomatic. These would have likely gone unnoticed under traditional paradigms. By deploying portable chest X-ray machines across underserved geographies, the campaign was able to leap over long-standing access barriers. More impressively, the use of AI-powered radiological tools allowed for real-time analysis, improving both accuracy and speed. These results provide empirical validation for the transformative potential of integrating artificial intelligence and mobile diagnos- tics into National TB programs.
The Government’s decision to scale up this AI- and X-ray-driven diagnostic approach is welcome. But it is only one piece of a larger mosaic of innovation reshaping TB care in India. A new generation of point-of-care diagnostic tools is on the horizon, radically altering what is possible in terms of accessibility and cost. Traditional sputum-based tests, while long considered the gold standard, are not always feasible — especially for children, the elderly, or patients in rural areas who may not produce quality sputum samples. In response, researchers are piloting non-invasive sampling techniques like tongue and nasal swabs, which could enable early and more comfortable TB detection. Open PCR platforms, another promising innovation, are poised to drive down costs and democratise access to high-quality molecular diagnostics across both public and private healthcare ecosystems.
The Indian Council of Medical Research (ICMR) is playing a vital enabling role here — facilitating trials, expediting evaluations, and helping incorporate new tools into standard practice. These efforts are part of a broader diagnostic overhaul that recognises TB detection not as a one-time act but a multi-step continuum involving screening, triaging, confirmation, and follow-up. Each stage must be designed to minimise attrition and maximise retention, especially in socio-economically vulnerable com- munities where TB hits hardest.
Beyond diagnostics, reducing TB mortality remains a pressing priority. Malnutrition, especially undernutrition, continues to be the most significant risk factor for TB progression in India. In response, the Government has strengthened nutritional support under the Nikshay Poshan Yojana (NPY), a direct benefit transfer scheme that now offers double the previous monthly support to TB patients. This expansion is not just an economic intervention but a therapeutic one. By helping patients meet their dietary needs during treatment, it improves adherence, builds immunity, and reduces risk of relapse — all of which are essential to breaking the disease’s grip.
Additionally, the shift towards differentiated models of TB care marks an important evolution in how India delivers treatment. Rather than a uniform one-size-fits-all approach, the new model recognises that TB patients vary widely in terms of clinical severity, socio-economic context, and co-morbidities. Early risk stratification now enables timely referral of severe cases to advanced care centres, while stable patients may continue their regimen through community-based support. More intensive inpatient care is also being prioritised where necessary. This layered model can significantly reduce TB-related deaths and must become a foundational principle of the National response.
However, while diagnostics, nutrition, and risk-based care models provide the bedrock of India’s TB strategy, the long-term goal — elimination — ultimately hinges on prevention. And that leads us to perhaps the most promising frontier: TB vaccination. The Covid-19 pandemic proved that global scientific collaboration, backed by robust funding and nimble regulatory systems, can compress vaccine development timelines from decades to months. That lesson must now be applied to TB.
India is already taking steps in this direction. An indigenous mRNA-based TB vaccine is currently in the early stages of development. Other vaccine candidates are at various phases of clinical trials, both domestically and globally. With its vast manufacturing infrastructure, clinical trial capacity, and public health delivery systems, India is uniquely positioned to lead the world in bringing a viable TB vaccine to market. In doing so, it would not only protect its own population but also make a historic contribution to global health equity.
International cooperation is also evolving in this direction. India has signed several strategic health partnerships under the aegis of G20 and WHO frameworks to enhance TB surveillance, data sharing, and technology transfer. The upcoming India-led South-South TB Innovation Platform is expected to facilitate cross-border collaboration among low- and middle-income countries, thereby extending the benefits of India’s innovation ecosystem to other high-burden nations.
Political commitment remains the cornerstone of this multifaceted response. Prime Minister Modi’s continued focus on TB — from domestic policy platforms to global forums — has elevated the issue from a public health challenge to a national mission. It has also encouraged other countries to set similarly ambitious targets. His leadership ensures that TB elimination remains high on the National development agenda, integrated across health, nutrition, innovation, and social justice.
But perhaps the most compelling feature of India’s TB response is its people-centricity. The active engagement of community health workers, civil society, local governance institutions, and survivors’ networks is helping convert patients into advocates, and healthcare into a shared responsibility. From the tribal belts of Jharkhand to the slums of Mumbai, these local champions are ensuring that no case is missed, no treatment interrupted, and no voice unheard.
As India approaches its 2025 deadline to eliminate TB, the task ahead remains formidable. Yet the convergence of political leadership, technological innovation, community mobilisation, and scientific excellence offers a path that is both realistic and replicable. If sustained and scaled, India’s model could serve not only as a beacon for countries battling TB but also as a blueprint for tackling other persistent public health challenges.
In the final analysis, eliminating TB in India is not just about defeating a disease — it is about affirming a fundamental right to health, dignity, and life for all. And in this national crusade, every diagnostic innovation, every nutritional intervention, and every political speech adds a brick to the edifice of a healthier, more equitable Bharat.

The writer can be reached at dipakkurmiglpltd@gmail.com