A Looming Health Crisis in India
India is facing a severe public health crisis as tuberculosis (TB) continues to spread despite the government’s ambitious goal of eliminating the disease by 2025. The country accounts for nearly a quarter of the world’s TB cases, with two deaths every three minutes attributed to the disease, according to the World Health Organization (WHO). Despite efforts to curb the spread, experts warn that the target is increasingly out of reach due to systemic challenges and socioeconomic barriers.
The situation is particularly dire in densely populated urban areas like Mumbai, where overcrowding, poor sanitation, and limited access to healthcare create ideal conditions for the disease to thrive. In the Govandi suburb, families live in cramped, unsanitary conditions, and TB has become a common presence. Doctors on the ground estimate that almost every second home in the area is affected, highlighting the scale of the problem.
Personal Struggles and Systemic Failures
Mehboob Sheikh, a 40-year-old man from Mumbai, is one of many who have been deeply impacted by TB. Diagnosed six months ago, he has lost significant weight and struggles with daily activities. His wife died of the disease a decade earlier, and now he faces the same fate. He has been on a nine-month course of antibiotics, but his condition remains fragile, and he is unable to work. His children, who are malnourished and vulnerable, rely on him, but he can no longer afford their school fees.
The personal toll of TB is compounded by systemic failures in India’s healthcare system. Public health facilities suffer from underfunding, staff shortages, and outdated infrastructure, while the private sector, though more accessible, is often unaffordable for the poorest. Diagnostic methods remain largely reliant on sputum microscopy, a technique over a century old, which can miss active cases. Modern molecular tests, which are more accurate, are used in less than 25% of diagnoses, leading to many infections going undetected and allowing drug-resistant strains to spread.
Government Efforts and Unmet Promises
In 2018, Prime Minister Narendra Modi set an ambitious goal: to eliminate TB by 2025, five years ahead of the WHO’s global target. While some progress has been made, including a 17.7% reduction in cases since 2015, the deadline is fast approaching, and the government’s promise is unraveling. A 2023 parliamentary report highlighted major challenges, including a lack of staff to maintain comprehensive treatment, vulnerability in mapping high-risk areas, and poor health-seeking behavior among the population.
The impact of the COVID-19 pandemic further exacerbated the situation, disrupting screenings, medicine supplies, and diverting health workers. Despite these setbacks, the government has continued to offer free TB testing and medicines through public health facilities, aiming to reach even the most vulnerable populations.
Innovations and Challenges in Diagnosis
In response to the diagnostic gap, India has begun adopting new technologies, including AI-powered X-rays and mobile testing vans. These tools aim to improve early detection and reduce delays in treatment. Portable AI devices, such as those developed by Qure.ai, can rapidly scan lung images and flag potential TB cases, making it easier to screen large populations in remote areas.
However, these innovations are not without challenges. AI scans do not diagnose TB or determine drug resistance, serving only as a screening tool. They must be followed by confirmatory tests, which are often unavailable in slums and rural areas. Despite this, the technology has shown promise in reaching underserved communities, with over 5 million X-rays performed using these devices.
Ongoing Struggles and Calls for Action
For individuals like Sheikh, the benefits of these advancements remain distant. He continues his free treatment at a government hospital but has not received the monthly cash assistance that TB patients are eligible for. Without financial support, he struggles to feed himself and his family.
Experts emphasize that while small victories in the fight against TB are important, more needs to be done to address the root causes of the crisis. “Having the target and getting things aligned is as important as meeting the deadline itself,” said Dr. Lancelot Pinto, a respiratory expert. “As long as it’s leading us in the right direction, we should consider these small victories as victories and push harder.”
