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In March this year, India quietly crossed an uncomfortable milestone. The country had pledged to eliminate tuberculosis by 2025, five years ahead of the global target. The deadline arrived. Tuberculosis remained.
The moment passed with little public attention. Yet it should have prompted a larger national conversation. How does a country that sends missions into space, creates vast digital systems for public services and seeks to join the ranks of advanced economies remain home to the world’s largest tuberculosis burden?
Part of the answer lies in the disease’s remarkable resilience—and in the social and economic conditions that continue to sustain it.
Long before doctors understood its cause, tuberculosis haunted households across the world as a slow wasting illness that seemed to consume life itself. Known as consumption, or phthisis in medical circles, it announced itself through a persistent cough, fever, night sweats and gradual physical decline. Eventually came the most dreaded sign—blood coughed into a handkerchief.
By the eighteenth and nineteenth centuries, tuberculosis had become the “White Plague” of Europe, the leading cause of death across much of the continent. Simultaneously feared and romanticised, it claimed figures such as John Keats, Frédéric Chopin and members of the Brontë family. India too has borne its share of loss, from Kamala Nehru to filmmaker Ritwik Ghatak.
For much of history medicine offered little hope. Patients were sent to remote sanatoria in mountains and forests where fresh air, sunlight and rest were believed to heal diseased lungs. The image became iconic: patients wrapped in blankets on open verandas, breathing deeply in the hope that nature might succeed where medicine could not.
Science finally intervened in 1882 when Robert Koch identified Mycobacterium tuberculosis, the bacterium responsible for the disease. Tuberculosis could now be understood not as a mysterious curse but as an infection caused by a specific organism. The discovery transformed diagnosis, treatment and public-health strategy.
Yet defeating tuberculosis proved far harder than identifying it. More than 140 years after Koch’s discovery, India reported approximately 2.8 million tuberculosis cases in 2025 and continues to bear the world’s largest tuberculosis burden.
In India, tuberculosis found fertile ground in overcrowding, undernutrition and poor access to healthcare. By Independence, it had already become a major public-health challenge. The establishment of the National Tuberculosis Institute in Bengaluru in 1959 and the adoption of the WHO-recommended DOTS strategy in the 1990s strengthened national control efforts, but eradication remained elusive.
Progress has nevertheless been substantial. Mortality has fallen dramatically from the pre-antibiotic era. Rapid molecular diagnostics have shortened the time required for diagnosis. Digital systems now track patients and treatment adherence with a sophistication unimaginable a generation ago.
Yet tuberculosis remains stubbornly entrenched.
The paradox is striking. India has become a global supplier of pharmaceuticals, vaccines and increasingly sophisticated healthcare technologies. Its hospitals attract patients from around the world. Yet within its own borders, a disease once associated with nineteenth-century poverty continues to infect millions on a scale unmatched anywhere else. Few public-health statistics reveal the gap between economic ambition and social reality more starkly.
Drug-resistant tuberculosis continues to pose a serious threat, requiring longer, more complex and more expensive treatment. At the same time, the disease is no longer confined to the poorest sections of society. Physicians increasingly report cases among the urban middle class, where delayed diagnosis, crowded environments and lifestyle-related vulnerabilities can contribute to transmission and disease progression.
Nor is tuberculosis confined to the lungs. Extrapulmonary disease affecting the spine, lymph nodes and reproductive organs is being diagnosed with increasing frequency. Uterine tuberculosis, once rarely discussed outside specialist circles, is now recognised as a significant cause of infertility among some women.
India’s missed elimination target reveals an uncomfortable reality. Tuberculosis is not merely a medical problem. It is deeply intertwined with nutrition, housing, sanitation, migration and access to primary healthcare. Antibiotics can cure the infection. They cannot cure the conditions that allow it to flourish.
AI-assisted systems can analyse digital chest X-rays within seconds, identifying patterns suggestive of tuberculosis and helping frontline healthcare workers decide which patients require further testing. This is particularly valuable in understaffed hospitals and clinics. Machine-learning tools are also being deployed to identify disease hotspots, monitor treatment outcomes and detect emerging patterns of drug resistance.
But enthusiasm should be tempered with realism.
Technology has often been mistaken for a substitute for public health. Tuberculosis has survived every previous generation’s confidence that a breakthrough was just around the corner. AI may make diagnosis faster and surveillance smarter, but it cannot replace adequate nutrition, decent housing, functioning primary healthcare and sustained patient support.
Tuberculosis has travelled with humanity for centuries—from the verandas of remote sanatoria to the algorithms of modern medicine. It has survived scientific breakthroughs, public-health campaigns and repeated predictions of its disappearance.
India’s missed elimination target is therefore more than a public-health setback. It is a reminder that becoming a technological power and becoming a healthy society are not necessarily the same thing. The persistence of tuberculosis exposes the limits of economic growth alone.
Artificial intelligence may help India find tuberculosis faster. But unless India addresses the conditions that allow the disease to endure—malnutrition, overcrowding and unequal access to healthcare—the world’s largest TB burden will remain stubbornly resistant to technological solutions.
Tuberculosis survives in India not because medicine has failed, but because social progress has lagged behind medical progress.
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Author Bio: Aloka Sengupta is a healthcare professional and commentator on health, international affairs and geopolitics.
These pieces are being published as they have been received – they have not been edited/fact-checked by ThePrint.