In the Mumbai suburb of Govandi, the sound of relentless coughing fills the air, painting a grim picture of the health crisis that plagues this densely populated area. Here, families live in cramped quarters, often under tarpaulin and salvaged wood, while the narrow lanes are waterlogged and suffocating. In India's financial capital, a deadly disease, tuberculosis (TB), lurks at every door. Doctors estimate that TB has infiltrated nearly every second home in this eastern urban compound, leading to fatalities and robbing families of their livelihoods.
This local crisis mirrors a larger national health care crisis, as India is home to a staggering 27% of the world’s TB cases. The World Health Organization (WHO) reports that two individuals die from this infectious disease every three minutes. The government has pledged to eliminate TB by the end of this year, yet experts warn that this goal is perilously out of reach due to significant gaps in the health care system and socioeconomic barriers hindering progress.
Mehboob Sheikh, a local resident, was diagnosed with TB six months ago, a grim reminder of his wife's death from the same disease over a decade ago. Sheikh describes his struggle, stating, “I have lost a lot of weight, I can barely walk now, and I get breathless if I speak more.” His condition has cost him his job at a printing press, and he now faces challenges in supporting his children, who are malnourished and too young to comprehend the gravity of their father’s illness.
In 2018, Prime Minister Narendra Modi made headlines by pledging to eliminate TB by 2025, a full five years ahead of the WHO’s global target. This ambitious goal entails reducing new TB cases by 80% and deaths by 90% compared to 2015 levels. However, this target is viewed as monumental, and with just months left until the deadline, TB continues to be one of India’s most persistent public health challenges.
India's struggle with TB is compounded by a combination of factors, including biological challenges, widespread poverty, and systemic health care gaps. According to Dr. Lancelot Pinto, an expert in respiratory health, “We are a high-burden nation. We do not necessarily have all the resources in place to scale up and eliminate TB by 2025.” The bacteria responsible for TB, Mycobacterium tuberculosis, has haunted humanity for millennia and can remain dormant in the body, developing resistance to treatments, which complicates eradication efforts.
The disease thrives in India’s impoverished areas, where access to consistent medical care is limited. Health worker Pramila Pramod, who has spent a decade in Govandi, notes that the number of TB patients she encounters each month remains constant. The suburb's narrow alleys create an ideal environment for TB transmission, with poor ventilation and unsanitary conditions. Fear of social stigma often leads patients to conceal their diagnoses from friends, neighbors, and even family members, further complicating treatment.
Compounding the issue is a struggling health care system riddled with underfunding, staff shortages, and outdated facilities. The private sector, while offering essential services, often remains unaffordable for many. Furthermore, India’s diagnostic strategy is outdated, relying heavily on sputum microscopy—a method that can miss active cases—while more modern molecular tests are underutilized.
15-year-old Sufiya Syed suffered for more than a year with chest pain, fever, and debilitating headaches before receiving a TB diagnosis two months ago. During her illness, her weight plummeted from 88 pounds to just 55 pounds. Now, with nausea and sleepless nights, she struggles to concentrate on her studies. The government has attempted to ramp up efforts by providing free TB testing and medications through public health facilities, aiming to ensure early diagnosis and treatment.
Some progress has been made, with India reporting a 17.7% reduction in TB cases since 2015, nearly double the global average decline. However, major challenges remain. A 2023 parliamentary report highlighted issues such as a lack of staff to maintain comprehensive treatment and inadequate mapping of high-risk areas. Additionally, the COVID-19 pandemic severely disrupted TB treatment and prevention efforts.
For years, diagnosing TB in India’s remote communities has been a struggle against time. USAID has played a crucial role in funding grassroots networks, but recent funding cuts threaten these efforts. In response, the Indian government is embracing innovative technologies, including AI-powered X-rays and mobile testing units, to enhance TB detection and treatment.
AI tools, such as Qure.ai's chest X-ray software, can rapidly analyze lung images and identify potential TB cases. This technology is especially vital in regions where trained radiologists are scarce. The Indian government has already performed nearly 5 million X-rays using these portable devices, facilitating earlier detection and treatment of TB cases.
Despite these advancements, individuals like Sheikh continue to face hardships. Although he receives free treatment at a government hospital, he expresses frustration over the lack of financial assistance available to TB patients. “No one has come to help us,” he laments. “I have no money left. I have to support and feed myself while I am alive.”
The fight against TB in India is ongoing, and while the government’s ambitious goals may seem daunting, the integration of innovative technologies and increased awareness offer hope for the future. As health experts emphasize the importance of early detection and comprehensive treatment, the struggle against TB continues to demand urgent attention and action.
