Over the past decade, India has cut new tuberculosis (TB) cases by 21%, almost twice the pace of the rest of the world, a testament to enduring political commitment, increased funding, and home-grown innovation in detection and care. India is now finding more TB patients than ever before. Now, with over 26 lakh cases recorded in 2025, the country is closing the long-standing gap of “missing” patients, reaching those who were always there but not diagnosed. In TB, being found is the first step to being cured.
As we acknowledge this hard-fought win, we must maintain this progress and accelerate towards global TB goals. Before we can eliminate TB (this could take decades), we must prevent all TB deaths and reduce catastrophic costs to families. Five priorities can help define the path ahead.
First, reducing TB deaths must become a central focus. It remains concerning that more than 3,00,000 people continue to die from TB each year, despite the disease being curable. A tailored and individualised approach — known as Differentiated TB Care — can help identify high-risk patients early and address their specific needs, such as comorbidities including diabetes, HIV, and malnutrition.
Timing is critical. Evidence shows that most TB patients who die do so within two months of diagnosis, with nearly half of these deaths occurring in just the first two weeks. Tamil Nadu’s TN-KET (TB Death-Free Project) demonstrates the impact of screening all TB patients with a simple five-sign tool to identify those at highest risk: Within six months of its launch in several districts, overall TB deaths fell by nearly 10%, while early fatalities declined by almost 20%.
The national programme’s move to adopt this approach is a welcome step, but it must now become the standard norm across the country. We need beds in every district to be earmarked for sick TB patients and intensive nutritional rehabilitation and alcohol de-addiction services, when needed.
Second, we must close the diagnostic gap; arguably, one of the most critical links in TB care. Studies suggest that nearly half of all TB cases are subclinical or asymptomatic — meaning individuals show no visible symptoms while continuing to transmit the disease. India’s strategy of expanding community-based screening is, therefore, both timely and essential. Encouragingly, several Made-in-India innovations can accelerate this effort, with TB testing moving to the doorstep. Portable AI-powered X-rays and simple non-invasive tongue or nasal swabs could enable testing closer to communities. And the vast lab network built during Covid-19 can now work for TB, with new Indian-made machines (Open PCR systems) that cut testing costs by 80%.
Third, focused action is needed for vulnerable populations, particularly tribal communities. TB rates among Scheduled Tribes are about 50% higher than among non-tribal populations. Addressing this disparity requires directed institutional attention.
Innovative financing mechanisms can support these efforts. District Mineral Foundation (DMF) funds were created to support communities affected by mining, many of whom live in tribal areas with a high TB burden, representing a largely untapped opportunity. With a national corpus of ₹1.03 lakh crore, nearly 60% of which remains unspent, even a small reallocation toward TB screening and diagnostics could have a significant impact. The Chamarajanagar DMF in Karnataka, for example, has invested in TB diagnostics, including molecular tests and X-ray services, offering a promising example for replication.
Fourth, India must adopt specific strategies to address TB in urban settings. Cities are emerging as major TB hotspots due to dense populations, high migration, and other risk factors. National plans alone cannot adequately address the diversity of urban challenges. Greater engagement with urban local bodies (ULBs) is, therefore, essential.
Just as Panchayati Raj institutions have been rallied in rural areas, ULBs can drive local ownership and accountability in cities. Integrating TB as a priority within municipal health planning is key, and with these bodies receiving more funds than ever through central grants, they are well-placed to lead TB efforts in urban areas. The experience of the Swachh Bharat Swachh Survekshan initiative demonstrates how local governments, when mobilised around a national priority, can deliver exceptional results. The capacity exists; it now needs to be directed towards TB as well.
Dedicated subcommittees within the national programme could help ensure that interventions are tailored to the environmental, social, and health system realities of tribal and urban low-income areas.
Finally, true elimination will depend on continuous investment in next-generation research — particularly new vaccines, diagnostics, and drugs, as well as epidemiological and operational research. India is well placed to take a leading role in advancing TB research, not only for its own population but also for countries across the Global South.
We are witnessing a renewed national focus on strengthening India’s research ecosystem, with the establishment of the Anusandhan National Research Foundation (ANRF). The ICMR could lead a TB Accelerator by setting priorities and standards, making available greater resources, establishing public-private-philanthropic partnerships and global collaboration, which would help accelerate breakthroughs, develop affordable tools, and shape solutions for high-burden settings worldwide.
India today has the momentum, the capacity, and the political will to end TB. The task now is to translate this momentum into a time-bound, accountable roadmap so that progress is not just retained, but accelerated.
Soumya Swaminathan is chairperson, MS Swaminathan Research Foundation and principal advisor, NTEP, ministry of health and family welfare. The views expressed are personal
