Drug-resistant TB is an emerging health security threat. Examine India's preparedness and suggest measures.

India has about a quarter of the world's new TB cases. WHO calls multidrug-resistant TB (MDR-TB) a public health crisis and a health security threat [1]. Drug-resistant TB can spread through the air and can no longer be cured with first-line drugs. India's TB programme is now strong on general TB, but its readiness for drug-resistant TB is still uneven.

Why drug-resistant TB is a security threat

• Airborne spread of resistant strains: these strains can move across borders and overwhelm health systems, much like a pandemic.
• Link to antimicrobial resistance (AMR): patients who stop treatment halfway breed even stronger resistance.
• High-risk groups: people with HIV, undernutrition or diabetes, and tobacco users, fall sick more easily [1].

India's preparedness: strengths

• Better case-finding: treatment coverage rose from 53% (2015) to 92% (2024) [2]. The TB Mukt Bharat Abhiyaan screened more than 25 crore people [1].
• Better results: TB deaths fell 38% since 2015, against 35% globally [1].
• Shorter treatment: the 6-month BPaLM oral regimen has been started under the national programme. More than 15,000 MDR/RR-TB patients are on it [3].
• Nutrition support: Ni-kshay Poshan Yojana support was doubled to ₹1,000 a month and extended to patients' families [4].

Gaps

• Misleading headline figure: the 94% treatment success rate covers only drug-susceptible TB [1]. It hides weaker results for MDR-TB.
• Slow BPaLM rollout: 15,000 patients is a small number next to India's share of world TB [1][3].
• Unregulated private sector: irregular prescribing and unsupervised drug sales keep producing new resistance.
• Lab gaps: rapid molecular testing for drug resistance is not yet available at every level of the health system.

Measures

• Test every diagnosed patient for drug resistance right away, using TrueNat and CBNAAT machines at block level.
• Make BPaLM the standard treatment everywhere, with digital adherence tracking through Ni-kshay.
• Report success rates separately for drug-susceptible TB and MDR-TB.
• Enforce Schedule H1 limits on the sale of anti-TB drugs, and link TB control to the National Action Plan on AMR.
• Pay the nutrition benefit at diagnosis and widen food support for households [4].

India has improved how it finds and treats TB. The next step is to bring the same reach to drug-resistant TB: test everyone early, move all MDR-TB patients onto short courses, and give families food support. That would protect the gains made under SDG Target 3.3 and turn TB Mukt Bharat into lasting health security.