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‘The Ticking Time Bomb’: A Doctor on Whether TB Can Be Eliminated From India

He states, “Despite a population of 1.3 billion, India has a mere 45 labs capable of distinguishing these TB types, which is 0.2 labs per million people. China, with its equivalent population, has 249 labs.”


Health Heroes – This article is part of a series to celebrate some of India’s most amazing doctors and to understand the incredible work they are doing.


“TB exists on an epic scale in India and stubbornly remains our most pressing public health problem—infecting nearly 300 million people, and killing two every three minutes. Unfortunately, this grim statistic has not changed over several decades,” says Dr Zarir Udwadia.

In a one-on-one with this renowned chest physician at Hinduja Hospital, Dr Priyamvada Chugh discusses India’s ticking time bomb—tuberculosis.

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Dr Udwadia has authored more than 140 publications. He was also the only Indian invited by the WHO to be on the TB ‘Guidelines Group’ in 2010.

What makes India a perfect cauldron where TB can thrive and spread?

Dr Zarir Udwadia. Source

“The combination of poverty, extreme overcrowding, malnutrition, diabetes, indoor air pollution, smoking, and HIV are the main culprits,” lists Dr Udwadia.

He continues, “Normal TB is simple to treat—with four drugs over six months for Rs 350, patients will almost always be cured.”

But if they are given the wrong drug or an incorrect dose, or are irregular with their medication, the bacteria can become resistant to this first-line of treatment, he informs.

“Such multi-drug-resistant forms of TB or MDR-TB are becoming increasingly common in India, with its burden estimated to be 79,000, which is likely an underestimate of the ground reality,” he warns.

Sadly, the treatment for MDR-TB is much longer, more expensive and complex. “It not only takes up to two years and Rs 2.5 lakh but also 250 injections and 15,000 pills, to be precise,” he details.

Sometimes, MDR-TB bacteria further gain resistance to second-line TB drugs like fluoroquinolones, often because of drug misuse and abuse.

The treatment options for such extremely drug-resistant TB (XDR-TB) cases that were first reported in India by Dr Zarir are long, expensive, and often toxic.

He shares, “While the development of novel drugs delamanid and bedaquiline for drug-resistant TB brings hope, at present, these drugs cannot be easily accessed in India.”

Can TB be eliminated from India—prevented, diagnosed, and treated?

Misdiagnosis and wrongful treatment causes patients to develop resistance to the TB bacterium. Source: Wikimedia Commons

“Preventing TB is a Herculean task. It means focusing on the bio-social—addressing the poverty and inequity that conspire to ensure TB stays firmly entrenched. It means education and basic hygiene. Now, you tell me how we would do all that in a city like Mumbai with a population nearing 20 million, with more than half that number having no permanent abode and living in slums,” shares Dr Udwadia.

He adds, “The need of the hour is to get the best second-line drugs to the hundreds of thousands of MDR-TB patients who otherwise die for lack of access,” he adds.

A crucial step towards treating TB, MDR-TB, or XDR-TB, would be to diagnose it right so that appropriate treatment can be given.

He states, “Despite a population of 1.3 billion, India has a mere 45 labs capable of distinguishing these TB types, which is 0.2 labs per million people. China, with its equivalent population, has 249 labs.”

Tuberculosis is also known as ‘the silent killer’. Source: Wikimedia Commons

With newer and more accurate MDR-TB diagnosis technologies like GeneXpert and its cheaper, faster and indigenous version TrueNat MTB test now available, as a country, we must embrace these innovations and scale-up their use.

The road ahead is long, and the time bomb is ticking—we need to act.

“If there is one national policy that I can change towards finding the ‘missing millions’ that remain undiagnosed, it would have to be the phasing out of the century-old sputum microscopy test for TB diagnosis and offering a sputum GeneXpert/TrueNat test upfront to every TB suspect.


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In a high TB and MDR-TB burden country like India, this would be the only way to proceed. “While I’m convinced this would reveal, in stark detail, the vast numbers of cases we have been missing, the question is—are we ready for the management of these missing millions, once we find them?” Dr Udwadia concludes.

(Edited by Shruti Singhal)

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