Global TB Report 2025: India’s Progress and Persistent Challenges
Global TB Report 2025: India’s Progress and Persistent Challenges
The World Health Organization’s (WHO) Global Tuberculosis Report 2025 highlights both achievements and ongoing challenges in the fight against TB. India, though still carrying the world’s largest TB burden, has reduced incidence by 21% since 2015. This progress is attributed to national campaigns, technology-driven interventions, and community-based initiatives. India’s goal of TB elimination by 2025 is ambitious, surpassing the global End TB Strategy target of 2035, reflecting strong government prioritization of public health and human development.
About the Global TB Report
The Global TB Report is WHO’s annual assessment of national and global TB progress. It evaluates trends in prevention, diagnosis, and treatment, while highlighting gaps such as drug resistance, underfunding, and disparities in healthcare delivery.
Key objectives include:
- Tracking progress: Monitoring TB incidence, mortality, treatment success, and preventive therapy coverage.
- Guiding policy and planning: Providing data to inform governments, NGOs, and donors on program design and resource allocation.
- Identifying bottlenecks: Revealing weaknesses in surveillance, diagnostic access, drug delivery, and MDR-TB response.
The 2025 edition emphasizes post-pandemic recovery, improved healthcare systems, and alignment with Sustainable Development Goal 3.3 to end epidemics of major communicable diseases.
Understanding Tuberculosis
TB is caused by Mycobacterium tuberculosis and primarily affects the lungs (pulmonary TB) but can also involve bones, kidneys, lymph nodes, and the brain (extrapulmonary TB). Transmission occurs via microscopic respiratory droplets from coughing, sneezing, or speaking. Poor ventilation, overcrowding, and undernutrition elevate the risk of infection, making TB a disease closely linked to poverty and social determinants.
Types of TB
- Pulmonary TB: The most common and contagious form, causing chronic cough, chest pain, fever, night sweats, and weight loss. Untreated patients can infect multiple people annually.
- Latent TB: Bacteria remain dormant without symptoms. About 5–10% of latent cases reactivate during a lifetime, particularly when immunity weakens.
- Active TB: Dormant bacteria become active, causing fever, weight loss, night sweats, and other symptoms. Treatment is essential to prevent spread and drug resistance.
Comorbidities such as HIV and diabetes complicate TB management, increasing severity and risk of poor outcomes.
Global Situation: Gains and Gaps
WHO’s analysis shows that while global TB control has recovered from COVID-19 disruptions, progress is uneven.
Incidence and Mortality Trends
Global TB incidence declined by approximately 1.7% between 2023 and 2024. Africa, South-East Asia, and Europe recorded steady reductions, whereas the Americas saw increases due to delayed screening and weaker surveillance. TB remains among the top ten global causes of death.
Regional Burden
- South-East Asia: 34% of global cases
- Western Pacific: 27%
- Africa: 25%
These three regions account for more than 80% of all TB cases, emphasizing the disease’s link with poverty and inequality.
High-Burden Countries
Eight countries—India, Indonesia, the Philippines, Pakistan, Bangladesh, Nigeria, China, and the Democratic Republic of Congo, constitute nearly two-thirds of global TB cases. India alone contributes roughly one-fourth of global incidence due to population size, socio-economic disparities, and limited access to healthcare.
Drug Resistance
MDR-TB, resistant to isoniazid and rifampicin, remains a global challenge. Only a fraction of patients receive appropriate treatment. Slow adoption of newer oral drugs, limited laboratory capacity, and treatment side effects hinder effective control. XDR-TB and pre-XDR-TB further complicate management, requiring longer and more expensive regimens. Innovations such as molecular diagnostics and digital adherence monitoring provide hope, but global scale-up is needed.
Funding Gap
Global TB financing remains below the required level. The WHO report cites a need for US$13 billion annually for research, diagnostics, and patient support, but current funding hovers around US$6 billion. The pandemic diverted resources to emergency response, leaving many TB programs underfunded. Sustainable financing, including domestic investment and innovative public-private partnerships, is essential for program continuity.
India’s Progress and Policy Achievements
Declining Incidence and Mortality
India’s TB incidence decreased from 195 per 100,000 in 2023 to 187 in 2024, with mortality dropping from 28 per 100,000 in 2015 to 21 in 2024. Progress is supported by improved nutrition, free drug access, community surveillance, and awareness campaigns.
Case Detection and Surveillance
India identified 2.61 million of an estimated 2.7 million TB cases in 2024. Ni-kshay 2.0 enables real-time tracking, reducing patient dropouts. Geotagging, digital adherence monitoring, and doorstep drug delivery have strengthened surveillance and treatment continuity.
Containing Drug-Resistant TB
India hosts nearly one-third of global MDR-TB patients. Expanded molecular testing (Truenat, CBNAAT) and shorter bedaquiline-based regimens have improved cure rates. The latest National TB Prevalence Survey informs targeted interventions in high-burden districts.
Key Initiatives
- Ni-kshay 2.0: Digital integration of patients, labs, and health facilities.
- TB-Mukt Bharat Abhiyan: Community-backed campaign promoting patient support via Ni-kshay Mitra.
- Upfront Diagnostics: Rapid molecular testing for all presumptive patients.
- Ni-kshay Poshan Yojana: Monthly nutritional support through direct cash transfers.
Global and National Efforts to Curb TB
Global Actions
The End TB Strategy (2015–2035) aims for a 95% reduction in deaths and 90% in incidence. Global initiatives include support from the Global Fund, Stop TB Partnership, and WHO guidelines for integrated TB, MDR-TB, and TB-diabetes management. Vaccine research is ongoing, with candidates such as M72/AS01E showing promise in adult populations.
India’s National Approach
India’s National Strategic Plan (2017–2025) emphasizes patient-centric, community-driven interventions. Initiatives include PM TB Mukt Bharat Abhiyan, doorstep drug delivery, private sector engagement, and district-level micro-plans. Integration of nutrition, social support, and technology ensures effective coverage.
Persistent Challenges
Despite progress, India faces ongoing hurdles:
- Undernutrition: Contributes to over 35% of TB cases.
- Drug Resistance: XDR-TB requires longer therapy and remains difficult to manage.
- Funding Pressure: Stagnant budgets limit diagnostic expansion and program growth.
- Private Sector Reporting: Many patients remain unnotified.
- Vaccine Gaps: BCG provides limited adult protection; next-generation vaccines are years away.
- Social Determinants: Poverty, overcrowding, and stigma hinder control efforts.
Way Forward
Sustaining TB control requires a combination of innovation, investment, and community engagement:
- Accelerate indigenous vaccine research and trials.
- Expand AI-assisted screening and mobile radiography services.
- Ensure predictable funding for diagnostics, treatment, and patient support.
- Integrate TB programs with nutrition, sanitation, and poverty-alleviation initiatives.
- Strengthen primary healthcare and digital surveillance for real-time monitoring and policy adjustments.
A multi-sectoral, holistic strategy combining medical, social, and economic interventions is essential for sustainable progress.
Conclusion
The Global TB Report 2025 tells a dual story of progress and challenges. India’s rapid decline in TB incidence and mortality is commendable, yet it still bears the highest global burden. Sustaining momentum through funding, innovation, nutrition, public-private cooperation, and community engagement is essential to achieve a TB-Mukt Bharat. Globally, success depends on models like India’s that integrate science, social support, and systemic reforms.