Tuberculosis: India's Biggest Infectious Killer

Why India carries the world's largest tuberculosis burden, the economic costs for families and the country, and the programmes to end TB.

Tuberculosis, or TB, is a bacterial disease that mainly affects the lungs. It is curable and preventable, yet it remains one of the world’s deadliest infectious diseases. India has the largest TB burden of any country, accounting for around a quarter of global cases, according to the WHO’s Global TB Report.

The economic costs

Lost income: TB mostly affects people in their working years. Patients may be unable to work for months.
Catastrophic costs: surveys have found that many TB-affected households in India face catastrophic costs, spending a large share of household income on the illness, including travel, lost wages and private care.
Poverty trap: TB is linked to poverty through crowded housing, undernutrition and limited health care, and it deepens poverty in turn.

Drug-resistant TB

Multidrug-resistant TB does not respond to the standard first-line drugs. It requires longer, more expensive and more toxic treatment. India has a large number of drug-resistant TB cases.

India’s response

National TB Elimination Programme: provides free diagnosis and treatment through public health facilities.
Nikshay Poshan Yojana, launched in 2018, provides monthly cash support for TB patients’ nutrition, since undernutrition worsens TB. The amount was raised in 2024.
Engaging private providers, since many patients first seek care in the private sector.
Active case finding and molecular tests for faster diagnosis.
Shorter treatment regimens for drug-resistant TB.

India set an ambitious goal of ending TB by 2025, ahead of the global target of 2030. Incidence and deaths have declined, though elimination remained a challenge.

Nutrition matters

A trial called RATIONS, conducted in Jharkhand and published in 2023, found that providing food baskets to household contacts of TB patients reduced TB incidence among them substantially, showing the value of nutrition support.

The cost of a cough

A daily wage labourer develops a persistent cough but continues working, visiting several private clinics without a clear diagnosis. By the time TB is confirmed, he has spent months of savings and infected family members. Free, fast diagnosis in public facilities and support for nutrition and income could have reduced both the spread and the financial damage.

Thinking TB is a disease of the past

TB is curable, but it remains a leading infectious killer worldwide, especially in India. Poverty, undernutrition and drug resistance keep it a major public health challenge.

Key takeaways

India has the world's largest TB burden, around a quarter of global cases.
TB causes lost income and catastrophic household costs.
Drug-resistant TB requires longer, costlier treatment.
Free treatment, Nikshay Poshan nutrition support and faster diagnosis are key responses.