India’s tuberculosis (TB) response is at a complex juncture. While overall TB incidence has declined, multidrug-resistant TB (MDR-TB) is emerging as a significant concern. According to the World Health Organization Global TB Report 2025, India accounted for 32per cent of global multidrug-resistant and rifampicin-resistant TB cases in 2024, even as overall TB incidence dropped by 21per cent since 2015.
Data from the National TB Elimination Programme (NTEP) Annual Status Report 2023–24 shows total TB notifications rising from 25.5 lakh to 26.07 lakh in 2024. At the same time, the number of patients undergoing treatment for drug-resistant TB is expected to increase from 134,000 in 2021 to over 200,000 by 2026. Treatment outcomes, however, are improving, with success rates reaching 75–80per cent through shorter, all-oral BPaL regimens, as highlighted in the India TB Report 2024.
Better Detection, Deeper Challenges
Experts note that the rise in MDR-TB cases reflects both improved detection and underlying systemic gaps.Dr. Sabine Kapasi, CEO of Enira Consulting , Founder of ROPAN Healthcare, and UN Advisor, explains, "Drug-resistant tuberculosis is increasingly shaping the next phase of India's TB response, not because the country has lost ground, but because it is now confronting the more complex edge of the epidemic. Over the past few years, detection has improved significantly, bringing greater visibility to drug-resistant cases that often remained underreported earlier. Globally, around 450,000 people were estimated to have developed drug-resistant TB in 2021, and India continues to account for a substantial share of this burden."
She further says, "programmatic data also indicates that the number of patients being treated for drug-resistant TB is rising steadily, with projections suggesting a sharp increase from about 134,000 patients in 2021 to over 200,000 by 2026. This rise reflects both improved diagnosis and the persistence of transmission risks. From a policy standpoint, the increase is closely linked to gaps that exist across the care continuum. Interrupted or incomplete treatment remains one of the most significant drivers, often resulting from socioeconomic constraints, migration, or limited patient support systems."
“In addition, uneven access to high-quality diagnostics and newer treatment regimens can delay appropriate care. Broader determinants such as undernutrition, co-morbidities, and population density further influence vulnerability and disease progression. At the same time, there are clear areas of progress. The expansion of molecular diagnostics, shorter all-oral treatment regimens, and strengthened surveillance under national programmes are improving both detection and outcomes. These interventions demonstrate that when systems are consistent and well-supported, drug-resistant TB can be managed effectively. The policy priority now is to build continuity and resilience, ensuring early diagnosis, uninterrupted treatment, and responsible antibiotic use. Addressing drug-resistant TB at scale is not only central to public health, but also critical to sustaining India's economic and social momentum,” Sabine adds.