Drug-resistant TB poses a health emergency in India

India speaks often about ending tuberculosis. Campaigns, targets, dashboards, and declarations dominate the national narrative. Yet within this broad TB discourse, drug-resistant TB (DR-TB), one of the deadliest forms of the disease, remains a neglected public health emergency. The Global Tuberculosis Report, 2025 of the World Health Organization shows progress: a 21% decrease in TB incidence in India, and an improvement from 53% to 92% in treatment coverage. But even within these gains are signs of crisis. Nearly 1,00,000 TB cases in India still go undetected each year, continuing to spread infection silently through communities. India accounts for almost a quarter of the world’s DR-TB burden, with an estimated 1.3-1.5 lakh new DR-TB cases emerging annually (WHO, 2025). Many of these individuals face delays in diagnosis and treatment initiation, worsening resistance, and driving transmission.

Behind every statistic is a life in upheaval, a young worker losing his job because treatment leaves him too weak to continue, a mother who can no longer hear her child due to drug-induced hearing loss, a student who quietly drops out of college after repeated hospitalisation. DR-TB emerges when TB bacteria become resistant to the most powerful first-line medicines. What follows is not simply a longer treatment schedule but a fundamentally different disease: harsh, toxic regimens stretching over months or years, lower cure rates, and higher mortality. DR-TB is not a peripheral challenge; it is an expanding threat capable of reversing India’s progress toward ending TB.

Uneven preparedness

Despite this, health-system preparedness remains uneven. While universal CBNAAT testing is the stated goal and technologies such as Xpert and TrueNAT continue to scale across the country, uptake is inconsistent, especially in remote areas. Delays in drug-resistance testing lead to patients being placed on empiric first-line regimens, particularly in the private sector, causing ongoing transmission of resistant strains. Even once diagnosed, access to appropriate care depends heavily on geography and socioeconomic status. Urban centres may offer specialist services and regular monitoring, but rural patients often travel long distances, lose wages, and take on debt simply to remain in care. Stock-outs of second-line drugs, fragmented referral pathways, and the persistent divide between public and private facilities further disrupt continuity of treatment.

Treatment itself is a battle. Severe nausea, joint pain, hearing loss, psychiatric side effects, and extreme fatigue push patients to their limits. While newer all-oral, shorter regimens such as BPaLM are being introduced and do improve tolerability, scale-up must accelerate to ensure equitable access for all eligible patients. Without structured support systems, mental health care, nutritional support, and income protection, patients are left to navigate complex regimens in isolation. Weak data systems and inconsistent reporting, especially from the private sector, obscure the real scale of the crisis. Steps such as the Nikshay Portal, which mandates online notification of all TB cases from both sectors, are improving real-time monitoring, but gaps remain.

DR-TB also reflects the social inequities that shape health outcomes in India. Poverty, food insecurity, overcrowded homes, stigma, and precarious livelihoods all increase vulnerability and complicate treatment adherence. DR-TB spreads fastest where people have the least protection. The consequences of this neglect are devastating — preventable deaths, permanent disabilities, long-term psychological trauma, catastrophic health expenditure (especially among those seeking private care), income loss, and deepening intergenerational poverty. From a public health perspective, uncontrolled DR-TB accelerates resistance, risking a future where even today’s second-line drugs fail, threatening workforce productivity, economic stability, and national health security.

Political and financial commitment

What India needs now is decisive political and financial commitment. DR-TB must be recognised and treated as the national emergency it is. Investments in diagnostics, second-line drugs, community-based care, psychosocial services, and robust follow-up systems must match the scale of the problem. Universal upfront drug-resistance testing must be non-negotiable for every individual diagnosed with TB. At the same time, the adoption and rapid scale-up of newer, shorter, safer regimens must become a national priority.

Active case finding among household and close contacts, especially children, along with the identification and treatment of latent TB infection (LTBI), will be crucial in breaking the cycle of transmission. Care models must shift decisively towards survivor-centred systems that embed mental health support, nutritional security, income protection, and community-based adherence mechanisms as core components of DR-TB care. The private sector, where many TB patients first seek care, must be fully integrated and held to common standards through mandatory reporting, standardised treatment protocols, and enforceable accountability. Existing public-private partnership models show promise; expanding them to more qualified centres can reduce the burden on the public system and improve access to quality TB care overall.

Equally urgent is dismantling the silence and stigma surrounding DR-TB. Stigma delays care, isolates survivors, and deepens mental distress. Media institutions, policymakers, and public agencies must help sustain national attention on DR-TB, building awareness and normalising conversations around prevention, testing, and treatment. Visibility is not optional; it is a public health imperative. Crises that remain hidden rarely receive the urgency they deserve.

Ending DR-TB in India is possible. The science exists. Tools are improving. Survivors and communities continue to lead the way. What remains uncertain is political resolve. India now has the opportunity to protect its people through early detection, safer treatment, holistic support, and committed follow-through. The question is simple: will we choose to treat DR-TB not as a footnote to the TB programme but as the health emergency it already is?

Chapal Mehra is a public health specialist and convener of Survivors Against TB (SATB), a collective of survivors, advocates, and experts working on TB and related co-morbidities. Views expressed are personal

Published – March 24, 2026 12:12 am IST