Closing In On TB
Progress in recent years is encouraging. According to the WHO's 'Global TB Report 2024', global TB incidence fell by 8.3 per cent between 2015 and 2023. India outpaced this trend, achieving a 17.7 per cent reduction. These gains reflect the focused efforts and commitment of the NTEP.
As we look to sustain and accelerate these gains, we must focus on closing the diagnostic gap — the most critical weak link in the TB care cascade. In 2023, an estimated 2.7 million people worldwide who developed TB were not diagnosed or notified. Without diagnosis, timely treatment is impossible, and the chain of transmission continues. Compounding this challenge is the emerging evidence that a significant number of TB patients do not exhibit symptoms. Studies suggest that this early stage of the disease, known as subclinical TB, may account for about 50 per cent of cases in high-burden settings, including India. This is likely a key driver of the ongoing transmission.
India's recently concluded 100-day intensified TB-Mukt Bharat Abhiyaan has provided several learnings. By screening vulnerable populations, including those without symptoms, the programme noted that the campaign identified 2.85 lakh asymptomatic TB patients — out of 7.19 lakh diagnosed. These individuals would likely have been missed under conventional, symptom-based screening approaches. By deploying portable chest X-rays, the campaign demonstrated the transformative potential of technology. AI-assisted reading of X-rays can detect lung abnormalities rapidly and accurately, allowing for quick identification of otherwise 'missing' cases. The government's plan to scale up this approach country-wide is encouraging and could serve as a global model.
A new generation of point-of-care diagnostic tools is transforming what's possible. Traditional sputum-based tests can be challenging, particularly for children and the elderly. But innovations — such as non-invasive sampling methods like tongue or nasal swabs — can help detect TB earlier and more affordably. The availability of open PCR platforms can be another game-changer — by cutting the cost of testing significantly, these platforms can make high-quality molecular diagnostics accessible across public and private settings. In India, several of these tools are already being piloted, and the Indian Council of Medical Research is playing a key role in facilitating their adoption into routine care.
Along with the upgradation of our diagnostic capacity, we must look at reducing mortality due to TB. India has taken important steps to improve supportive care, including the doubling of monthly nutritional support under the Nikshay Poshan Yojana (NPY) — a direct cash transfer scheme that helps patients meet their dietary needs during treatment. This expansion is timely, as undernutrition remains one of the leading risk factors for TB progression.
The country is also moving toward differentiated models of TB care, where services are tailored based on a patient's risk profile and severity at diagnosis. This includes early risk stratification, timely referral of severe cases to higher-level facilities, and the provision of more intensive inpatient care where needed. This approach can drive down mortality appreciably and must become a core feature of the TB response. We must prioritise reducing TB deaths to as close to zero as possible in the near future.
While these advancements in diagnostics, treatment, and care delivery are crucial, we must not lose sight of the long-term solution — an effective TB vaccine. The experience of developing Covid vaccines demonstrates how global collaboration, streamlined regulatory pathways, and strong public investment can significantly accelerate timelines — an approach that must now be applied to TB vaccine development. India, with its scientific leadership and manufacturing capacity, is uniquely placed to drive the development and equitable deployment of next-generation TB vaccines, just as it did with Covid. An mRNA vaccine is in an early stage of development in India, and others are at various stages of clinical trials.
PM Modi's leadership has played a pivotal role in keeping TB elimination high on the national agenda and inspiring other countries to set ambitious goals. With continued political commitment, evidence, data-informed policies and a strong focus on innovation, India can drive transformative change in the global fight against TB.
The writer is chairperson, MS Swaminathan Research Foundation and principal advisor, NTEP, Ministry of Health and Family Welfare
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