Underinvestment in TB research and innovation keeps the world reliant on century-old tools. Examine the gaps and suggest how India can lead South-South collaboration.

Tuberculosis made 10.7 million people ill and killed over 1.2 million in 2024 [4]. Yet TB research and innovation received only $1.2 billion in 2023, against a target of $5 billion a year [1]. As a result, prevention still relies on the BCG vaccine, which is more than a century old, and on long drug regimens. India carries the largest share of the burden and also has strong domestic capacity, so it is well placed to close this gap.

Gaps in TB research and innovation

• Funding gap: Research gets less than a quarter of its target [1]. Funding for care is also short: about $6.6 bn is available against the $22 bn/yr needed for the UNHLM 2027 targets [1].
• Vaccine gap: BCG gives adults little protection, and no newer vaccine has reached wide use.
• Treatment gap: Drug-resistant TB still needs long and costly treatment, so dropout rates are high.
• Diagnostic gap: Low-cost point-of-care tests are scarce in places with high TB rates.
• Donor-dependence gap: The Global Fund's 2024–26 cycle was cut by US$1.4 bn (11%) [2]. Donor funding fell 14% to $0.94 bn in 2025 [1]. This shrinks the pooled money that pays for global trials.
• Burden-innovation mismatch: More than 80% of cases are in low- and middle-income countries (LMICs) [1], but research money and agenda-setting are concentrated elsewhere.

How India can lead South-South collaboration

• Lead by example: India's TB incidence fell 21% between 2015 and 2024, from 237 to 187 per lakh [3]. Its model of active case-finding and free treatment can be shared with other countries.
• BRICS pooling: BRICS countries provide 65% of domestic TB funding in LMICs [1]. India can push for a joint BRICS fund for vaccine and drug trials.
• Regional push: The South-East Asia Region has 35% of new cases [1]. India can host multi-country trials and shared regulatory reviews in the region.
• Affordable manufacturing: India's generic-drug industry can supply affordable diagnostics and new regimens to other countries.
• Health diplomacy: India can offer training, digital tools such as Ni-kshay, and help to countries left exposed by donor cuts.

Closing the research gap needs both more money and countries of the Global South working together. If India moves from leading by example to leading through partnership, the world can replace century-old tools with modern ones. That would advance SDG 3.3 and make the goal of ending TB achievable.