[Answered] Examine the reasons for India missing the 2025 TB elimination target despite high case diagnosis. Critically analyze the systemic gaps contributing to the global burden.

Introduction

Despite diagnosing over 26 lakh TB cases in 2024 and achieving 92% treatment coverage, India remains far from the 2025 elimination target, reflecting persistent structural, biomedical, and socio-economic barriers highlighted by the Global TB Report 2025.

TB Burden of India

1. India accounts for the world’s largest tuberculosis (TB) burden—27.1 lakh cases and over 3 lakh deaths in 2024.
2. Despite progress in case detection and treatment coverage, the country has missed its ambitious goal of eliminating TB by 2025.
3. A combination of systemic weaknesses, social determinants, and programmatic disruptions continue to impede India’s march toward “End TB”.

Reasons For India Missing The 2025 Tb Elimination Target

High diagnosis but slow decline in incidence and mortality

1. The Global TB Report 2025 shows India achieved a 21% reduction in TB incidence and 28% reduction in deaths since 2015—far below the 2025 milestones of 50% incidence reduction and 75% mortality reduction.
2. Elimination, defined as <1 case per million, remains distant. Although India diagnosed more than 80% of estimated cases, its large absolute burden means even small undiagnosed percentages translate into huge numbers—contributing 8.8% of the global gap in undetected TB.

COVID-19 disruptions and programmatic diversion

1. The COVID-19 pandemic severely disrupted TB services, causing diagnostic delays, treatment interruptions, and resource diversion.
2. Studies by the Indian Council of Medical Research (ICMR) show that TB notifications fell by 25% during 2020, and the backlog took years to recover—resulting in increased community transmission and drug resistance.

Persistent drug-resistant TB burden

1. India accounts for one-third of global drug-resistant TB (DR-TB) cases. 3.64% of new cases and 12.63% of previously treated cases were drug-resistant in 2024.
2. Transmission of untreated DR-TB poses epidemiological challenges, raising treatment costs and prolonging infectiousness. Despite the rollout of all-oral regimens (BPaL), access gaps remain, especially for children.

Gaps in treatment adherence and preventive therapy

1. Treatment completion remains a challenge due to socioeconomic vulnerabilities, migration, stigma, and long treatment courses.
2. Non-adherence increases relapse and DR-TB.
3. Preventive therapy for high-risk contacts—central to WHO’s strategy—remains underutilized due to supply shortages of isoniazid and rifapentine, and weak follow-up mechanisms.

Social determinants: malnutrition, pollution, diabetes

TB is a “disease of poverty.”

1. Malnutrition accounts for 34–40% of India’s TB cases (Lancet Public Health, 2022).
2. Air pollution, especially in urban areas like Delhi, worsens TB outcomes.
3. Diabetes contributes 3.2 lakh cases in 2024, creating a syndemic relationship between chronic and infectious diseases.
   These structural determinants amplify transmission and reduce treatment success.

Uneven availability of diagnostics and drugs

1. Despite innovations like AI-enabled handheld X-ray devices and expanded GeneXpert coverage, gaps persist: intermittent shortages of first-line drugs (as reported in 2024), weak diagnostic access in tribal and remote regions, insufficient paediatric formulations.
2. This limits the reach of the Ni-kshay ecosystem, though it remains a strong platform for digital treatment monitoring.

Private sector engagement and regulatory challenges

1. Nearly 50% of TB patients first seek care in the private sector, where notification, standardised treatment, and follow-up remain inconsistent.
2. Although the Private Provider Interface Agency (PPIA) model in Mumbai and Patna showed success, national-scale integration remains incomplete.

Conclusion

Disease control fails without addressing structural inequities. India’s TB elimination requires biomedical innovation combined with stronger health systems, social protection, and sustained multisectoral action.