India continues to bear the brunt of the TB epidemic

The latest WHO report data are not flattering for India. India can and must do better.

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WHO’s 2018 Global TB Report was released in New York yesterday. The report showed that progress against TB has been slow. Globally, an estimated 10 million people developed TB in 2017. The number of new cases is falling by  2% per year. This is too slow for meeting the global end TB goals. 

Overall, TB deaths have decreased over the past year. In 2017, there were 1.6 million deaths. In 2017, 558000 people were estimated to have developed disease resistant to at least rifampicin– the most effective first-line TB drug. Worldwide in 2017, 6.4 million new cases of TB were officially notified to national authorities and then reported to WHO. So, only 64% of the estimated 10.0 million new cases that occurred in 2017 were notified. The rest are considered missing (either not diagnosed or not notified). Ten countries accounted for 80% of the 3.6 million global gap, the top three being India (26%), Indonesia (11%) and Nigeria (9%)

India continues to rank as the highest burden country in the world (table below). In 2017, an estimated 2.7 million people developed TB disease, and over 400000 people died. So, India accounts for 27% of the global estimated cases, and 25% of the estimated deaths. In 2017, the case fatality ratio (which is a ratio of estimated mortality and estimated incidence) for India was an astounding 0.16, which shows an unacceptably high rate of fatality among those who developed TB. Improving the quality of TB care is critical for preventing such deaths

Drug-resistance continues to be a concern in India. An estimated 65,000 people were estimated to have either multi-drug resistance (MDR), or rifampicin-resistance.TB treatment coverage (which is notified/estimated incidence)in 2017 was only 65%. This means too many people are falling through the cracks and not getting adequate treatment.

In March of this year, Indian Prime Minister Narendra Modi launched the TB Free India campaign at the Delhi End TB Summit. In his opening speech, he declared that “India is determined to address the challenge of TB in mission mode. I am confident that India can be free of TB by 2025.” 

While everyone has welcomed India’s ambitious plan of TB elimination by 2025, the world is watching whether India will follow up on the prime minister’s commitment with the substantially increased budget that is required, and rapidly execute the ambitious TB Free India campaign. 

This year's WHO TB Report shows inadequate progress in India. So, unless India really steps up the game and makes serious investments, it is highly unlikely that TB can be eliminated by 2025.

Next week, on 26th September, Heads of State will attend the first ever UN High Level Meeting on TB at the UN General Assembly in New York. I sincerely hope Prime Minister Modi will lead the Indian delegation and show leadership in the global fight against TB. But, for India, the fight must start at home - too many Indians are dying of a curable infection and it is time to stop the senseless loss.

Madhukar Pai

Associate Director, McGill International TB Centre

I am a Professor and a Canada Research Chair in Epidemiology & Global Health at McGill University, Montreal. I serve as the Associate Director of the McGill International TB Centre. URL: