Every year, World Tuberculosis Day (March 24) brings with it a familiar moment of reflection for public health systems around the world. It is an opportunity to take stock of progress against one of humanity’s oldest infectious diseases. In India’s case, that reflection often leads to a complicated conclusion. There has been progress, undeniably so. Yet the scale of the problem remains enormous.
Over the past decade, India has expanded its tuberculosis detection and treatment efforts at a pace few countries have attempted. Screening networks have grown, diagnostics have become faster, and treatment programmes now reach millions of patients across the country. These efforts are beginning to show results. Still, India continues to carry the largest share of the global tuberculosis burden.
According to the World Health Organization (WHO)’s Global Tuberculosis Report 2025, India accounted for roughly a quarter of all tuberculosis cases worldwide in 2024. At the same time, the country has managed to bring down incidence rates steadily over the past several years. Between 2015 and 2023, TB incidence in India declined by about 21%, reflecting sustained work under the National TB Elimination Programme.
Even so, the numbers remain large enough to give policymakers pause. In 2023, the country’s TB incidence was estimated at around 187 cases per 100,000 population, an improvement from the 195 cases per 100,000 reported a year earlier. Yet this is still some distance from India’s elimination target of 44 cases per 100,000 population by 2025, which represents an 80 per cent reduction from 2015 levels.
This is where the conversation about tuberculosis in India begins to change shape. The issue is no longer only about the scale of infection. Increasingly, it is about the complexity of the disease itself.
Antibiotics remain the cornerstone of tuberculosis treatment globally, and given India’s TB burden when resistance develops, treatment becomes prolonged, more expensive and less predictable.
In that context, drug resistant tuberculosis has emerged as one of the most visible expressions of antimicrobial resistance within infectious disease control. When resistance develops, the implications are immediate. Treatment becomes longer, more demanding for patients, and far more expensive for health systems.
WHO estimates indicate that the country accounts for the largest share of multidrug resistant and rifampicin resistant TB cases globally. In fact, nearly one third of the world’s MDR and rifampicin resistant TB cases are estimated to occur in India.
These infections behave very differently from standard drug sensitive tuberculosis. A typical TB infection can often be treated with a six month regimen of first line medicines. Drug resistant TB, however, may require treatment lasting nine to eighteen months or longer. Patients often need second line medicines that demand careful monitoring and may cause more severe side effects.
Molecular diagnostic technologies have played a vital role in India’s National TB Elimination Programme to significantly strengthen TB detection and treatment delivery. Advancements such as Rapid nucleic-acid amplification tests are able to identify TB and detect rifampicin resistance within hours rather than weeks, enabling patients to begin appropriate treatment earlier.
Yet technology alone cannot solve the problem. Diagnostic networks rely on something less visible but equally critical: Reliable systems. Molecular testing requires uninterrupted supplies of cartridges, laboratory reagents and trained technicians. When those supply chains experience disruptions, even briefly, the effects are felt immediately in testing centres and clinics.
In a high burden country such as India, delays in diagnosing drug resistant infections can quickly translate into delays in treatment. That in turn increases the risk of continued transmission within communities.
Treatment access presents another layer of complexity. WHO has recommended newer, shorter and entirely oral regimens for several forms of drug resistant tuberculosis. These regimens have the potential to improve patient adherence and treatment outcomes by reducing the length and physical burden of therapy.
However, making these regimens widely available requires careful coordination. Procurement systems must function smoothly. Clinicians need training in the updated treatment protocols. Monitoring frameworks must ensure that medicines are used appropriately so that resistance does not develop further.
Taken together, these realities highlight why tuberculosis control today cannot be viewed in isolation from the broader challenge of antimicrobial resistance. TB programmes are now tasked not only with diagnosing infections and delivering treatment, but also with preventing the emergence and spread of resistant strains.
India’s long-term strategy reflects this recognition. Through initiatives under the National TB Elimination Programme and complementary efforts under the National Action Plan on Antimicrobial Resistance, the country has prioritised expanded surveillance, improved diagnostics and responsible antibiotic use.
Looking ahead, the central question may not simply be whether elimination targets are met within a specific timeframe. A more durable objective may be building health systems resilient enough to prevent resistance from reversing the progress already achieved.
That means strengthening surveillance networks so resistant infections are detected early, maintaining reliable diagnostic capacity across thousands of laboratories and ensuring uninterrupted access to effective medicines while protecting those medicines from misuse that accelerates resistance.
India’s scale makes this challenge formidable. Yet it also creates an opportunity. The country operates one of the largest tuberculosis control programmes in the world. The lessons emerging from this experience, from diagnostic expansion to treatment monitoring, have the potential to inform global strategies for managing drug resistant infections.
Tuberculosis can, therefore, be viewed in a slightly different light. It remains a major public health burden, but it is also a signal about how health systems respond to antimicrobial resistance. In many ways, the fight against tuberculosis and the wider battle against antimicrobial resistance have now converged into a single challenge.
This article is authored by Saransh Chaudhary, president, Global Critical Care, Venus Remedies and CEO, Venus Medicine Research Centre.
