In March 2018, India made a surprising announcement in a full auditorium on World TB Day. India would eliminate tuberculosis by 2025. Five years ahead of the global target.
India did want to eliminate TB, but it was no easy task. Also, no one knew how or its cost. As we sit in mid-2026, with no elimination in sight, it’s time to introspect and ask: What should we do for TB beyond 2025?
India, energised, has certainly made progress on TB-expanded diagnostics, digital tracking systems, nutritional support schemes, and support initiatives. Important initiatives. Yet, insufficient for ending TB.
Government efforts, yield limited results, because 50% India’s TB cases remain diagnosed and treated in its vast private sector. Also, the social determinants of TB: Poverty, inequality, malnutrition, overcrowding, and health expenses remain unaddressed. Clearly a response that does not engage the private sector and address some, if not all, the social determinants, is not an effective one.
Even today, millions continue to experience delayed diagnosis, interrupted treatment, financial hardship, stigma, and isolation throughout their TB journey. If we add harder to cure drug-resistant TB, to this mix we have extensive suffering, transmission, poverty and debt. TB persists because it remains a social, economic, and human rights issue.
A cohesive response to India’s TB crisis, is to look at the lived experiences of those affected both in the public and the private sector and learn from them. To create awareness on early diagnosis, include technologies that are quick, detect drug resistance early and ensure that they remain affordable.
A critical aspect is treatment. Current treatment, however, effective leaves the individual with little or no support. The focus is on compliance rather than quality of care. Particularly damaging when treatment brings severe side effects. The new regimens that have received much attention need more effective distribution and access. Perhaps the problem is that they remain unavailable to those within the private sector.
An important aspect of treatment is awareness and choice. Individuals often do not know what kind of TB they have nor do they know what choices they have in treatment. This approach to treatment must change. Those affected need treatment literacy, support for managing side effects and mental health care.
TB is gendered where women, trans folks and sexual and gender minorities remain the most vulnerable to systemic discrimination. We need to change that by implementing care that is more gender responsive. A start would be to have zero tolerance within clinical settings as also counselling for families.
We all know TB disproportionately affects the vulnerable, and poor. Yet schemes such as Nikshay Poshan Yojana give only ₹1,000 every month for nutritional support. A key action point here would be to raise the amount to ₹3,000 considering current inflation and food prices. We should be ensuring that that every Indian has food security because evidence shows it remains a sure way to reduce latent Tb infection from progressing to active TB.
Inequities exist within the TB response itself. Migrant workers, urban poor communities, tribal populations, people living with HIV, and undernourished populations continue to face risks. Specialised programmes for these subgroups are critical.
Stigma follows TB like a shadow. A large-scale unpacking of the roots of stigma is needed–a public conversation. As is building public and health system literacy and sensitisation.
Finally, there is the elephant in the room–the private sector that treats 50% of all TB cases. Partnerships with the private sector require persistence, collaboration, and empathy. A top-down approach won’t work. It will require governments, health care systems, researchers, civil society organisations, and survivors to continue working together with urgency.
These are not revelations but knowledge available if governments engage survivors–to understand their lived experiences. Beyond using them as talking heads at events or as low-cost labour for community engagement. It’s time to work with the community. To engage them as partners, who provide input, and become spokespersons. When these voices shape programmes, policies become more grounded, and effective.
We have an opportunity to reimagine the TB response. A TB-free India will emerge not just from better technology or faster diagnostics but also a true partnership with communities and the private sector.
(The views expressed are personal)
This article is authored by Chapal Mehra, queer writer, activist and public health specialist, New York.
