For decades, India’s approach to TB has focused on ‘control’, as reflected in its old name — the Revised National TB Control Programme (RNTCP). But Prime Minister Narendra Modi’s goal to eliminate TB created an urgency to act, and the elimination goal is now a rallying cry, encouraging fieldworkers and policymakers alike to dream bigger and aim higher. In 2019, the RNTCP transmuted into the National TB Elimination Programme (NTEP).

The commitment to TB elimination also unlocked significant resources. Over the past decade, funding for TB programmes has increased dramatically — from ₹1,200 crore in 2015 to ₹3,300 crore in 2024. This financial boost has enabled new diagnostic tools, medicines, and mass screening initiatives. For instance, portable handheld X-ray machines powered by artificial intelligence are now being used to detect TB among vulnerable individuals in far-flung corners of the country.

Beyond biomedical interventions, the government has also invested in the social determinants of TB through schemes such as the Nikshay Mitra (which encourages community and corporate sponsorship for TB patients), Nikshay Poshan Yojana (which provides cash transfers for nutritional support), and Jan Arogya Yojana (focused on early detection and awareness). These schemes have provided a much-needed social safety net and reinforced the importance of community participation in TB care.

Regrettably, the Covid-19 pandemic was a significant setback; as human resources and healthcare infrastructure were redirected to combat the virus, TB detection and treatment took a hit. However, as long as we can sustain our political and financial commitment to eliminating TB, India can realistically achieve this audacious goal in the coming years. The 100-day TB elimination campaign, spearheaded by health ministry’s deputy director general Dr Urvashi Singh and launched across 347 districts, highlights the Indian government’s steadfast commitment to eliminating tuberculosis.

The greatest obstacle now is policy implementation. While political will and resources are in place, more consistent grassroots execution is needed. Logistical inefficiencies, gaps in training, and stigma continue to undermine progress. Addressing these issues is crucial to sustaining the gains achieved so far. To move forward, India must focus on three critical areas.

We must strengthen capacity by ensuring district TB officers, who are the bridge between policy and practice, have technical skills, leadership training, and access to cutting-edge tools like ultraportable X-rays. Second, instead of restricting itself to the biomedical paradigm, the NTEP can partner with existing programmes, such as the public distribution system, to address social determinants like malnutrition, poor living conditions, and stigma contributing to higher TB incidence and unfavorable outcomes. These efforts will not only impact our efforts towards TB elimination, but also improve broader health outcomes. Third, innovative policies from the Centre must be paired with robust monitoring and evaluation. Regular audits and data-driven adjustments are essential to improve impact. Partnering with researchers can help identify barriers, optimise strategies, and ensure district accountability.

India has reimagined its TB response with remarkable results, but the path to elimination demands even greater urgency and resolve. India can transform its bold vision into a global model for tackling TB by focusing on grassroots capacity, addressing social determinants, and ensuring accountability. Eliminating TB is not just a fight against disease but a fight for equity, dignity, and the promise of healthier lives for millions. Achieving this goal will reaffirm India’s leadership in global health, proving that even the most entrenched pandemics can be overcome with collective determination.

Manoj Jain (MD MPH) is an infectious disease physician at Emory University in Atlanta, US.

Pranay Sinha (MD SM) is an infectious diseases physician at Boston University in US.

Kenneth G Castro (MD) is a physician-scientist at Emory University in Atlanta, US.