E-Paper
India’s DR-TB problem: When silence, delays, and half-measures cost lives
Authored by - Chapal Mehra, public health specialist, New Delhi and Zarir Udwadia, consultant physician, Hinduja and Breach Candy Hospitals, Mumbai.
India likes to describe its tuberculosis response in the language of ambition. Elimination targets, global leadership, mission-mode action are catchphrases. Yet drug-resistant tuberculosis (DR-TB) in India tells a different story: Delayed diagnosis, uneven treatment, biased data systems, and an absence of transparency. If TB is India’s unfinished business, DR-TB is its most obvious blind spot.
India has the highest DR-TB burden globally a disease that is not merely “harder to treat” but a biological signpost that systems have failed. It is evidence of delayed diagnosis, incorrect or interrupted treatment, inadequate regimens, or no follow-up. Patients endure months, sometimes years, of medications that take a profound physical and psychological toll. Cure is often uncertain. Side effects can be irreversible.
The most troubling aspects of India’s DR-TB response is how late resistance is often detected. Universal drug susceptibility testing is still not universally available across India. Too many continue to be started on standard TB treatment without checking for resistance. When resistance is finally identified, sometimes months later, the disease has advanced, the body is weaker, and the public health risk far greater. This is a systemic failure with predictable consequences.
Once diagnosed, access to quality DR-TB care depends heavily on geography and socioeconomic status. Urban patients may find specialised centres and trained teams; rural patients often undertake repeated, exhausting travel for consultations, tests, and medicines. Stock disruptions of second-line drugs, though improved in recent years, still exist. The result is fragile continuity of treatment for a disease that demands consistency and adherence.
The treatment itself remains punishing. DR-TB regimens are notorious for their toxicity. Severe nausea, hearing loss, psychiatric disturbances, joint pain, and crushing fatigue are not “manageable side effects” but often life-altering conditions. New regimens offer hope but access remains challenging. Also, mental health services, nutritional support, and income protection remain inadequate in routine DR-TB care.
Public health responses are only as strong as the data that guide them. Underreporting of TB and DR-TB, particularly from the private sector, is widely acknowledged. Treatment outcomes are not always easily accessible for independent scrutiny. Even as 2025 ended, the India TB Report for the year has still not been released. In any serious disease elimination programme, such data delays are unthinkable and harmful. They slow course correction, weaken accountability, and obscure challenges.
DR-TB flourishes in environments shaped by poverty, malnutrition, overcrowding, in our cities and elsewhere. For many families, a DR-TB diagnosis triggers not only a medical crisis but an economic collapse. Loss of income, mounting travel costs, nutritional needs, and long treatment durations push households into debt and long-term instability. These social pressures, in turn, fuel non-adherence and poor outcomes. A response that focuses narrowly on pills and protocols while ignoring these conditions fails people.
Each failure to diagnose early, each interruption in treatment, each helpless person increases the pool of DR-TB. The spectre of untreatable TB is not a distant dystopia; it is a reality. This is not just about TB, but about antimicrobial resistance, and national health security.
India’s strategy on DR-TB now requires more than reaffirmation of intent. It requires a reset. Resistance testing must become truly universal and truly upfront. Newer, shorter, safer regimens must be rapidly decentralised rather than confined to selected centres. Survivor-centred care must be implemented in real terms, not confined to policy alone. This includes mental health services, nutritional support, and social protection as core components of care, not charitable add-ons.
The private sector must be engaged, monitored and fully aligned with national DR-TB standards through enforceable notification, standardised regimens, and clear accountability mechanisms. A disease of this scale cannot be controlled through voluntary compliance alone.
Above all, transparency must be restored to the centre of TB governance. The routine, timely publication of national TB and DR-TB data is an ethical obligation. Without current data, it is impossible to know whether strategies are succeeding, stagnating, or failing. Delayed reporting sends exactly the wrong signal at a moment when urgency is paramount.
India undeniably has the scientific knowledge, clinical expertise, and manufacturing capacity to confront DR-TB. What remains uncertain is whether it has the urgency to act with the speed and seriousness the disease demands. It responds to early detection, uninterrupted treatment, social support, and hard accountability.
History will not judge India by the ambition of its targets, but by the reality of its outcomes. The longer DR-TB remains on the margins of national attention, the heavier that judgment will be.
This article is authored by Chapal Mehra, public health specialist, New Delhi and Zarir Udwadia, consultant physician, Hinduja and Breach Candy Hospitals, Mumbai.
