India, a high-burden nation for tuberculosis (TB), is grappling with the persistent challenges of this infectious disease despite a government pledge to eliminate it by 2025. Experts caution that this lofty target would go well beyond the World Health Organization’s (WHO) own global target of 2030, by five years. They warn it is still perilously far from grasp. Dr. Lancelot Pinto, a pulmonologist and expert in respiratory health, shows us how these biological, social, and systemic factors intertwine. These factors are fueling India’s long-standing war with tuberculosis (TB).
There, as in other districts, such as Govandi suburb of Mumbai, the need is now acute. Tuberculosis has spread into almost every other home, sickening so many. Her community is left with tight, water-filled streets that serve as perfect breeding ground for the disease to thrive. Meanwhile, residents are living with the harsh realities of cancer, disease and death. Socioeconomic worker Pramila Pramod emphasizes the challenges of sensitizing communities and addressing the stigma associated with TB.
The Reality of Tuberculosis in Govandi
In Govandi, the effects of the epidemic are all too real. The disease has resulted in the loss of millions of lives and devastated many families and communities, taking away entire generations of breadwinners. Social worker Pramila Pramod reports that “no one has come to help us,” highlighting the community’s isolation and lack of support. Social stigma compounds these obstacles and creates additional challenges in their own right. Pramod emphasizes how families will hide TB from public knowledge to avoid social stigma. Sometimes that young girl is being married off. Her parents will never let anyone know she has TB,” she says. I don’t know how will they ever find a boy for her. Otherwise.
The story of Mehboob Salim Sheikh, a 40-year-old Govandi resident sheds light on the personal cost of TB. Sheikh after losing his wife to the disease a decade ago, Sheikh now fights TB himself. He describes his struggle: “Every day when I wake up, I feel like I am going faint and completely black out.” Sheikh, despite being on a nine-month course of antibiotics, doesn’t think there’s any doubt that his body still feels frail and weakened. His lack of money makes it harder for him to be cured, as he confesses, “No money, no more money. I have an obligation to myself to support and feed myself while I am alive.”
Challenges in Diagnosis and Treatment
India’s current diagnostic strategy is a major obstacle in the fight against the TB crisis. Today, almost three quarters of new diagnoses are found using sputum microscopy, an antiquated technique first adopted around 140 years ago. This dependence on outdated methods makes it difficult to detect and effectively treat quickly. Dr. Lancelot Pinto stresses the importance of proactive measures, stating, “So, unless we detect and treat proactively – not just wait for symptoms – we’ll continue to miss cases.”
As recent advancements demonstrate, there is still great hope in the fight against TB. The Indian government has increased budgets for TB initiatives and is deploying modern tools like AI-powered X-rays, mobile testing vans, and drones to transport samples for analysis. Advocates and experts warn that these steps fall short to reach an elimination target by the year 2025. This is what concerns Dr. Pinto the most. He warns that we may not have the resources currently available to end TB by 2025.
Additionally, a 2023 Parliamentary Standing Committee report highlighted significant hurdles confronting India’s TB programs. These include staff shortfalls, lack of mapping of high-risk areas, and low health-seeking behavior of communities. These compounding issues have created a perfect storm, enabling TB to continue spreading even after significant progress to control it.
Progress Amidst Setbacks
Given these overwhelming obstacles to success, the accomplishments in narrowing TB’s case burden throughout most of India is still an encouraging success story. Since 2015, the country has made a 17.7% reduction in their TB cases, almost two times the global average rate of decline. Perhaps unsurprisingly, death rates have seen dramatic improvements, dropping from 28 to 22 per 100,000 people.
In this work, USAID has been an important partner in bolstering these grassroots networks in India’s most marginalized communities. Since 1998, it has funneled more than $140 million into the fight against TB in remote regions that are difficult to access. Advocacy, community outreach, education, and support—such as the ones above—have been pivotal in raising awareness, decreasing stigma, and increasing access to healthcare resources.
As these small victories add up, they become important steps forward, which Dr. Pinto welcomes. Setting the target and getting everyone aligned is as essential as the deadline, he remarks. Read his blogpost below as he calls for us all to do more to combat TB while acknowledging the steady and systematic gains achieved thus far.
