India missed its 2025 TB elimination target yet outpaced the global decline in incidence. Critically examine the drivers and the remaining gaps.

According to the WHO Global TB Report 2025, India's TB incidence fell 21% between 2015 and 2024, against 12% globally [1]. However, the National Strategic Plan 2017–25 had aimed for elimination by 2025, five years ahead of the SDG deadline [2]. India therefore succeeded in relative terms but fell short of its absolute goal.

Drivers of faster decline

• Finding missing cases: "missing" (unreported) cases fell from 15 lakh (2015) to 2.5 lakh (2023). Notifications reached a record 26.07 lakh in 2024, which shows better detection rather than more spread [2].
• Active screening and technology: the 100-Day Abhiyaan screened 12.97 crore vulnerable people [3]. It used handheld X-rays, AI triage and the Ni-kshay digital tracking system [1].
• Treatment reach: 92% treatment coverage against 78% globally, with TB deaths down 28% [1]. Drug-resistant TB success rose from 68% to 75% with all-oral regimens [2].
• Nutrition and Jan Andolan: Ni-kshay Poshan Yojana pays ₹1,000 a month by DBT. Ni-kshay Mitras, 46,118 TB-free Gram Panchayats and youth-led JOSH teams add community support [1][2].

Remaining gaps

• Distance from the target: incidence fell only from 237 to 195 per lakh (2015–23) [2]. Halving it would require about 119. The End TB 50% milestone was also missed worldwide [4].
• Hidden asymptomatic TB: 2.85 lakh of 7.19 lakh cases found in the campaign had no symptoms [3]. Screening still depends on campaigns, and India accounts for 8.8% of the global case-detection gap [4].
• Nutrition left to charity: the RATIONS trial in Jharkhand showed that food for household contacts cut TB by about 40% [5]. Yet support for contacts depends on voluntary Ni-kshay Mitra donors.
• Catastrophic costs: about half of TB-affected households worldwide spend more than 20% of their income on TB [6]. ₹1,000 a month does not make up for lost wages.
• Drug resistance: India carries 32% of global MDR/RR-TB [4]. About one in four DR-TB patients is still not successfully treated, which adds to AMR.
• Funding: global TB funding is falling [2].

India's gains come from better detection, treatment coverage and community mobilisation. The causes that keep producing new cases, namely hunger and family poverty, have been only partly addressed. The way forward is to make X-ray screening of high-risk groups a routine task at Ayushman Arogya Mandirs and to fund food for household contacts from the budget. Social protection should also cover lost income. A steady rate of decline, not a deadline, should be the test. Making these changes can bring the SDG 3.3 target for 2030 within reach and uphold the right to health under Article 21.