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lite.cnn.com - on gopher - inofficial | |
ARTICLE VIEW: | |
This country’s government vowed to eliminate TB by the end of 2025. | |
It’s not going well. | |
Ayushi Shah, CNN | |
Updated: | |
8:04 PM EDT, Sat September 20, 2025 | |
Source: CNN | |
Relentless coughing echoes through the Mumbai suburb of Govandi, where | |
families live cramped under tarpaulin and salvaged wood. The narrow | |
lanes are waterlogged and airless, and here in India’s financial | |
capital, a deadly disease is lurking at every door. | |
Doctors on the ground estimate that tuberculosis has infiltrated almost | |
every second home of this eastern urban compound, killing residents and | |
robbing many families of their livelihoods. | |
The local crisis is a microcosm of a national health care crisis. India | |
is home to 27% of the world’s TB cases and records an average of two | |
deaths related to the infectious disease every three minutes, according | |
to the World Health Organization (WHO). | |
The government has pledged to eliminate the disease by the end of this | |
year – but experts say that goal is dangerously out of reach – with | |
health care system gaps and socioeconomic barriers stalling efforts. | |
Mehboob Sheikh was diagnosed with TB six months ago – more than a | |
decade after his wife died of the disease. For him, the realities of | |
living with it are far too real. | |
“I have lost a lot of weight, I can barely walk now, and I get | |
breathless if I speak more,” he told CNN, his gaunt face and hollow | |
eyes symptoms of his plight. | |
The disease has already cost him his job at a printing press – the | |
relentless fatigue and weakness left him unable to cope with the long | |
shifts on his feet. Sheikh has been on an extended nine-month course of | |
antibiotics, but with just three months of that treatment left, his | |
body is still frail. Any sign of a recovery is hard to see. | |
His children – malnourished, vulnerable and too young to understand | |
– hover around while he coughs. | |
Once earning 15,000 rupees ($171) a month, he now struggles to pay | |
their school fees. | |
“If my body holds on, I will keep living. If not… that’s the | |
end.” | |
A national crisis | |
In 2018, Prime Minister Narendra Modi stunned global health circles by | |
pledging to eliminate TB by 2025 – five years ahead of the WHO’s | |
global target. Elimination means cutting new TB cases by 80% and | |
deaths by 90% compared with 2015 levels. | |
Experts viewed the government’s 2025 target as a monumental | |
challenge, and just months ahead of the deadline, TB remains one of | |
India’s most stubborn public health crises. | |
India’s struggle with the disease, experts say, is fueled by a potent | |
combination of biology, poverty and systemic health care gaps. | |
“We are a high-burden nation,” said Dr. Lancelot Pinto, an expert | |
in lungs and the respiratory system, in Mumbai. “We do not | |
necessarily have all the resources in place to scale up and eliminate | |
TB by 2025.” | |
The bacteria that causes the disease, Mycobacterium tuberculosis, has | |
haunted humanity for millennia, with traces found in Egyptian mummies. | |
It can remain dormant inside the body for years and develop resistance | |
to drugs, making it difficult to eradicate. | |
The disease thrives in India’s densely populated, impoverished | |
pockets, where people have little access to consistent medical care. | |
After 10 years working in Govandi, health worker Pramila Pramod says | |
the number of TB patients she sees every month has remained the same. | |
The suburb’s alleys create the perfect transmission pathway, with no | |
cross-ventilation, open drains clogged with garbage, and families of | |
six huddled in single rooms. Fear of social stigma means some patients | |
hide diagnoses from neighbors, schools, even spouses. | |
“Sometimes there is a young girl of marriage age. (Her) parents | |
won’t tell anyone she has TB,” said Pramod, who volunteers at Alert | |
India, a non-governmental organization that works with people affected | |
by infectious diseases. “How will they find a boy for her | |
otherwise?” she recalls them asking. | |
This vulnerability is exacerbated by a struggling health care system | |
where the public sector is plagued by decades of underinvestment, staff | |
shortages and outdated facilities. The country’s vast but unregulated | |
private sector, while providing essential and crucial services, can be | |
costly to access. | |
India’s diagnostic strategy is another major hurdle. Nearly | |
three-quarters of diagnoses still depend on sputum microscopy, a method | |
first introduced around 140 years ago, that can miss active cases. The | |
more modern molecular tests – which accurately detect the | |
bacteria’s DNA – are used in a little over 1 in 4 diagnoses, | |
according to Pinto. | |
This gap means countless infections go untreated and dangerous, | |
drug-resistant strains spread undetected. “So, unless we detect and | |
treat proactively – not just wait for symptoms – we’ll continue | |
to miss cases,” Pinto said. | |
The government’s promise | |
Chest aches, fevers, debilitating headaches and chills pained | |
15-year-old Sufiya Syed for more than a year before doctors finally | |
diagnosed her two months ago. | |
As TB took over her body, her weight dropped from 88 pounds to 55 | |
pounds (40 kilograms to 25 kilograms). During that time, she still went | |
to school. Now, she says she can’t focus on her studies, with nausea | |
and sleepless nights leaving her body struggling to battle the disease. | |
“Every day when I wake up, I feel like I am going faint and | |
completely black out,” she said. “Sometimes I don’t have food for | |
four or five days. My mom forces me to eat.” | |
The government has ramped up efforts by offering free TB testing and | |
medicines through public health facilities, aiming to ensure early | |
diagnosis and treatment, reaching even the most vulnerable populations. | |
Some progress has been made. | |
India has reduced cases by 17.7% since 2015, nearly double the global | |
average decline, and deaths have dropped from 28 to 22 per 100,000 | |
people, according to data from India’s Ministry of Health and Family | |
Welfare. | |
But with just months to go until the government’s end-of-2025 | |
deadline, its promise is unraveling. | |
Major challenges, including a shortage of staff to maintain | |
comprehensive treatment, vulnerability in mapping in high-risk areas | |
and poor health-seeking behavior, have allowed the disease to persist, | |
according to a 2023 parliamentary report on the government’s | |
eradication push. | |
The Covid-19 pandemic worsened matters. Lockdowns halted screenings, | |
disrupted medicine supplies and diverted health workers, the report | |
said. | |
CNN has contacted the Indian government’s Directorate General of | |
Health Services for a response. | |
‘Small victories’ | |
For years, diagnosing TB in India’s remote communities has been a | |
losing race against time, where vast distances to clinics, a chronic | |
shortage of radiologists and a reliance on outdated sputum tests meant | |
infections festered undetected, often until they were dangerously | |
advanced. | |
Since 1998, USAID filled some of the gap in India’s TB fight, | |
channeling more than $140 million to fund grassroots networks in the | |
nation’s hardest-to-reach corners. But recent US funding cuts have | |
threatened to unravel these hard-won gains. | |
While not publicly acknowledging the shortfall, India has boosted | |
domestic budgets and is deploying an arsenal of new tools, including | |
AI-powered X-rays, mobile testing vans and drones ferrying samples. | |
Artificial intelligence is increasingly being used to speed up the | |
fight against TB. Tools like Qure.ai’s chest X-ray software can | |
rapidly scan lung images and flag patients who may have active TB – a | |
critical step in countries where trained radiologists are scarce. | |
Confirmatory tests that analyze sputum or detect TB at the molecular | |
level are more accurate, but they require labs, equipment, and time – | |
resources often unavailable in slums and rural India. Integrated in | |
portable machines, AI-powered X-rays help bridge that gap by flagging | |
potential TB cases, allowing health workers to quickly refer those | |
patients for confirmatory tests, reducing delays that often cost lives. | |
Health experts caution, however, that the scans do not diagnose TB or | |
reveal whether the disease is drug-sensitive or drug-resistant. | |
Instead, they function as a screening and triage tool – catching | |
cases earlier, reducing the number missed by basic symptom checks, and | |
ensuring that patients are referred for proper sputum or molecular | |
testing before starting treatment. | |
That speed and reach matter in India, the world’s most populated | |
country, where crowded living conditions make early detection crucial | |
to stopping the spread of TB. | |
“These machines weigh less than 3.5 kilos and can be carried in a | |
backpack,” said Qure.ai’s chief medical officer for global health, | |
Dr. Shibu Vijayan. “They run on batteries, so you can screen an | |
entire community in one day without needing power.” | |
The devices are making it easier to reach people who might otherwise | |
fall through the cracks. In the capital Delhi, for instance, the | |
Clinton Health Access Initiative has deployed more than 30 | |
backpack-sized machines in harder-to-access areas, and hundreds more | |
across the country. | |
“We know that certain groups are most vulnerable – slum dwellers, | |
migrant workers, people exposed to dust,” Vijayan said. “The tiny | |
X-rays make it possible to offer them tests in their community | |
settings.” | |
Cost is another breakthrough: the portable units are half the price of | |
traditional hospital X-ray machines. | |
The Indian government has embraced the approach, incorporating AI | |
screening into its national strategy. It has performed nearly 5 million | |
X-rays with the devices, according to Vijayan, and officials are | |
procuring additional devices. | |
“Having the target and getting things aligned is as important as | |
meeting the deadline itself,” Pinto said. “As long as it’s | |
leading us in the right direction, we should consider these small | |
victories as victories and push harder.” | |
But for people like Sheikh, there is little to celebrate. | |
He continues his free treatment at a government hospital every month, | |
with his son helping to bring his medicines home. But the help ends | |
there. He says he has not received any monthly cash assistance that TB | |
patients qualify for as part of a federal government program. | |
“No one has come to help us,” he said. “I have no money left. I | |
have to support and feed myself while I am alive.” | |
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