Mumbai
–
A merciless cough passes through Govandi, a suburb of Mumbai, where the family lives under the tarpaulin and rescued wood. The narrow lanes are flooded and airless, and fatal illnesses are lurking in every door in financial capital here in India.
Ground doctors estimate that tuberculosis has permeated almost the second home of this eastern urban compound, killing residents and taking away many families’ livelihoods.
The local crisis is a microcosm of the national healthcare crisis. According to the World Health Organization (WHO), India has 27% of global tuberculosis cases, recording an average of two deaths related to infections every three minutes.
The government has pledged to eliminate disease by the end of the year, but experts say the goal is dangerously out of reach – says gaps in the health system and socioeconomic barriers are stagnating.
Mehboobob Sheikh was diagnosed with tuberculosis six months ago. It’s been more than 10 years since his wife died of illness. For him, the reality of living with it is too realistic.
“I lost a lot of weight, I can barely walk, and if I speak more I’ll get out of breath,” he told CNN to his ga haughty face and his light-like blank eyes symptoms.
This illness has already cost him his job on the printing press – merciless fatigue and weakness have made him unable to cope with his long shifts. Shake is involved in a nine-month extension course of antibiotics, but his body is still frail as he only has three months left in the treatment. Signs of recovery are hard to see.
His children are malnourished, vulnerable, and incomprehensibly young – floating while he coughs.
Earn 15,000 rupees ($171) a month, he struggles to pay his tuition.
“If my body gets caught up, I’ll continue to live. Otherwise… that’s the end.”
In 2018, Prime Minister Narendra Modi surprised the global health circle by pledging to eliminate TB by 2025. Removal means reducing new TB cases by 80% and death by 90% compared to 2015 levels.
Experts view the government’s 2025 target as a monumental challenge, and just a few months before the deadline, tuberculosis remains one of India’s most stubborn public health crises.
Experts say India’s struggle with illness is supported by a strong combination of biology, poverty and systematic health care gaps.
“We are a fierce nation,” said Dr. Lancelot Pinto, a lung and respiratory system expert in Mumbai. “We don’t necessarily have all the resources in place to expand and eliminate TB by 2025.”
The disease-causing bacteria, Mycobacterium Tuberculosis, has been plagued by humanity for thousands of years when traces are found in Egyptian mummies. It can remain dormant in the body for years, develop resistance to drugs, making it difficult to eradicate.
The disease thrives in India’s densely populated poor pockets, with people having little access to consistent healthcare.
After working for 10 years at Govandi, healthcare worker Pramila Pramod says the number of tuberculosis patients he sees each month remains the same.
Suburban alleys create the perfect transmission path without cross-ventilation, open drains clogged with garbage, and six families hanging themselves in single rooms. Fear of social stigma means that some patients hide their diagnosis from their neighbors, schools, and even spouses.
“There may be girls who are younger than they are married. (her) parents don’t tell anyone who has tuberculosis,” said Pramod, who volunteers for Alert India, a non-governmental organization that works with people affected by the infection. “How do they find a boy for her?” she recalls asking them.
This vulnerability is exacerbated by a struggling health care system in which the public sector is plagued by decades of underinvestment, staff shortages and outdated facilities. The country’s vast and unregulated private sector can be expensive to access while providing essential and critical services.
India’s diagnostic strategy is another major hurdle. Almost three-quarters of the diagnosis still relies on Sputum Microscopy, a method originally introduced about 140 years ago. According to Pinto, more modern molecular testing (which accurately detects bacterial DNA) is used in four diagnoses in one or more diagnoses.
This gap means that countless infections are untreated and dangerous, and drug-resistant strains spread undetectable. “So, not only wait for symptoms, but we continue to miss cases unless we actively detect and treat them,” Pinto said.
Chest pain, fever, debilitating headaches and chills hurt 15-year-old Sufiya Syed over a year ago.
As tuberculosis took over her body, her weight fell from 88 pounds to 55 pounds (40 to 25 kg). Meanwhile, she still went to school. Now she says she can’t concentrate on her research. Nausea and sleepless nights say her body is struggling to fight illness.
“Every day I wake up, I feel faint and completely black,” she said. “Sometimes, I don’t have food for four or five days. My mother gives me food.”
The government has stepped up its efforts by reaching the most vulnerable populations, aiming to provide free tuberculosis testing and medicines through public health facilities and ensure early diagnosis and treatment.
Several advances have been made.
According to data from the Ministry of Health, India has fallen 17.7% since 2015 and since 2015, almost double the global average decline, with deaths per 100,000 from 28 to 22.
But the promise is cleared just a few months before the government’s deadline at the end of 2025.
A 2023 parliamentary report on promoting government eradication revealed that key challenges including shortages of staff to maintain comprehensive care, vulnerability to mapping in high-risk areas and reduced health-seeking behaviors have enabled the persistence of the disease.
The Covid-19 pandemic has exacerbated the problem. The report said the lockdown was stopped, destroying drug supplies and diverting health workers.
CNN has contacted the Government of India’s Health Services Department to contact you about the response.
For years, a diagnosis of tuberculosis in remote Indian communities means that large distances to clinics are maintained, chronic shortages of radiologists, and reliance on outdated sput testing often means that they are not infected until dangerously progressive.
Since 1998, USAID has filled some of the gaps in India’s TB fight, channeling over $140 million to fund grassroots networks in the country’s most difficult corners. However, recent cuts in US funding have threatened to unravel these struggling benefits.
Although it has not publicly admitted the shortage, India is boosting its domestic budget and deploying new tools of weapons, including AI-powered X-rays, mobile test vans and drone ferry samples.
Artificial intelligence is increasingly being used to speed up the fight against tuberculosis. Tools like Qure.ai’s chest x-ray software can quickly scan lung images and flag patients who may have active TB. This is an important step in a country where there is a shortage of trained radiologists.
Confirmation tests that analyze or detect sputs at the molecular level are more accurate, but require labs, equipment, and time. It is often not available in slums or rural India. AI-powered X-rays integrated into portable machines help fill that gap by flagging potential TB cases, allowing healthcare professionals to quickly refer those patients for verification tests, reducing delays that often take lifespans.
However, health experts should note that the scans do not diagnose tuberculosis or reveal whether the disease is drug-sensitive or drug-resistant. Instead, they act as screening and triage tools. Catch cases early, reduce the number of missed cases in basic symptom checks, and ensure that patients are referred to an appropriate sput or molecular test before treatment begins.
Its speed and reach in India, the world’s most populous country, is why its busy living conditions make early detection essential to stop the spread of TB.
“These machines weigh less than 3.5 kg and can be carried by a backpack,” said Dr. Shibu Vijayan, Chief Medical Officer of Global Health at Qure.AI. “They run on batteries so they can screen the entire community in one day without the need for electricity.”
The device is easier to reach people who could otherwise pass through the crack. In Delhi, for example, the Clinton Health Access Initiative has deployed over 30 backpack size machines in more difficult access areas, and hundreds more machines across the country.
“We know that certain groups are the most vulnerable — slum residents, migrant workers, people exposed to dust,” Vijayan said. “The small x-rays allow us to provide testing in a community setting.”
Cost is another breakthrough. Portable units cost half the price of traditional hospital X-ray machines.
The Indian government has embraced an approach to incorporating AI screening into its national strategy. According to Vijayan, the device has run nearly 5 million x-rays, and authorities are procuring additional devices.
“Having a target and adjusting things is just as important as meeting the deadline itself,” Pinto said. “As long as it guides us in the right direction, we should consider these small victories as victory and push them harder.”
But for people like Sheikh, there’s very little to celebrate.
He continues to receive free treatment at government hospitals every month, and his son helps bring his medicine home. But the help ends there. He says TB patients are not receiving monthly cash assistance that they are eligible as part of their federal government program.
“No one came to help us,” he said. “I have no money left. I have to support and feed myself while I’m alive.”
