India has outperformed global averages in reducing TB incidence and mortality, yet remains the world's largest TB-burden country. Critically analyse the gaps in India's TB elimination strategy.

The WHO Global TB Report 2026 shows that India's TB mortality has fallen 38% since 2015, against a global fall of 35% [1]. India's incidence fell 21%, while global incidence fell 12% [2]. Yet India still has about a quarter of the world's new cases [1]. This gap shows a strategy that is good at curing TB but weak at preventing it.

Achievements: where India outperforms

• Treatment coverage rose from 53% (2015) to 92% (2024) [2].
• 94% treatment success for drug-susceptible TB (DS-TB) [1].
• TB Mukt Bharat Abhiyaan screened over 25 crore people (Dec 2024–Nov 2026) [1].

Gaps in the elimination strategy

• Strong on cure, weak on prevention: deaths fell almost twice as fast as new cases (38% vs 21%) [1][2]. Elimination is measured by incidence, and treatment alone cannot bring incidence down.
• Social risk factors: undernutrition, diabetes, HIV and tobacco use drive TB risk [1]. Nutrition and NCD programmes are still not fully joined up with TB control.
• Catastrophic costs: worldwide, about half of TB-affected households spend more than 20% of their income on TB, and lost wages count as a cost [1]. Free medicines do not replace lost earnings.
• Thin nutrition support: Ni-kshay Poshan Yojana paid only ₹500 a month until it was raised to ₹1,000 in November 2024 [3]. The money also starts only after diagnosis, too late to stop spread within the household.
• MDR-TB: WHO calls it a public health crisis [1]. The 6-month BPaLM regimen has reached only 15,000+ patients [4], which is small against India's burden.
• Unclear data: different documents give different success rates, 94% for DS-TB [1] and 90% in an official document [4]. Combined figures hide where the programme is weak.

Way forward

• Pay the first nutrition instalment at diagnosis through Ni-kshay DBT. Widen the 2024 move to support patients' families into a full prevention measure [3].
• Make BPaLM the standard MDR-TB treatment across the country [4].
• Combine TB screening with diabetes, HIV and tobacco-cessation programmes.
• Report DS-TB and MDR-TB outcomes separately.

In short, India has largely fixed treatment; the next step is to stop people falling sick. Nutrition support for families, protection against lost income, community backing through Ni-kshay Mitra and control of drug resistance can turn falling deaths into falling new cases, in line with SDG target 3.3 of ending the TB epidemic by 2030.