No Indian State TB-Free Yet: What the 2026 Gap Reveals

What "TB-Free" Actually Means in India

In global health, disease "elimination" has a precise technical meaning. <cite index="80-1">TB elimination, in strict terms, means fewer than one case per 10 lakh (one million) population.</cite> The WHO's End TB Strategy, adopted in 2014, targets a 90 percent reduction in TB deaths and an 80 percent reduction in incidence compared to 2015 levels — by 2035, with interim milestones in 2020 and 2025.

India's Sub-National Certification (SNC) system translates these global standards into a tiered recognition framework for individual states, union territories, and districts. <cite index="65-1">Under the SNC, a district or union territory achieves TB-free certification when it demonstrates an 80 percent reduction in TB incidence from 2015 levels, a 90 percent reduction in TB deaths, and ensures that no TB-affected household faces catastrophic expenditure because of the disease.</cite>

Districts that don't yet reach that threshold but show meaningful progress can still be recognised. <cite index="74-1">Districts winning a 20 percent incidence decline receive a Bronze award, 40 percent earns Silver, 60 percent earns Gold, and only an 80 percent or more decline — verified through house-to-house surveys and secondary data — earns full TB-free certification, along with a ₹10 lakh monetary award.</cite>

These are demanding criteria. For context, India's national average incidence has fallen by 21 percent since 2015 — a creditable achievement, but well short of the 80 percent bar required for even a single state to claim the title.

Who Has Made It — and Who Hasn't

<cite index="65-1">In 2021, Lakshadweep became India's first and only union territory to be declared TB-free, four years before India's national target of eliminating TB by 2025.</cite> As of mid-2026, it remains the only certified TB-free administrative unit at the UT level. The State TB Officer for Lakshadweep told ThePrint in 2026 that only seven active TB cases had been reported in the territory so far in 2026 — a striking contrast to the mainland's burden.

<cite index="71-1">Five units in total have achieved End TB targets under India's sub-national certification: the UT of Lakshadweep, and the districts of Anantnag, Budgam, and Pulwama in Jammu & Kashmir, and The Nilgiris in Tamil Nadu. A dozen more districts are described as close to achieving similar status.</cite>

No full state has crossed the line. The highest-burden states — Uttar Pradesh, Maharashtra, Bihar, and Madhya Pradesh — account for the largest share of India's caseload. <cite index="76-1">Delhi records the highest infection prevalence rate among states and union territories.</cite> Meanwhile, <cite index="55-1">TB prevalence rates vary from as high as 747 per 100,000 population in Delhi to as low as 149 per 100,000 in Kerala</cite> — a nearly fivefold difference within a single country.

[REVIEWER: add clinical insight here — e.g., what district-level or state-level programme elements you have seen make a measurable difference in TB incidence reduction, and what the practical barriers to sub-national certification look like from a field perspective]

India's 2025 Deadline: Missed, but Not Without Progress

Prime Minister Modi announced at the Delhi End TB Summit in 2018 that India would eliminate TB by 2025 — five years ahead of the WHO's 2030 global goal. <cite index="58-1">India is the only country in the world that had set an elimination deadline of 2025.</cite> That deadline has now passed, and the target was not met.

The honest picture from the WHO Global TB Report 2025: <cite index="77-1">India's TB incidence fell from 237 per lakh population in 2015 to 187 per lakh in 2024 — a 21 percent reduction, nearly double the global average decline of 12 percent.</cite> TB mortality dropped by 25 percent in the same period. Treatment coverage improved dramatically, <cite index="83-1">rising from 53 percent to 92 percent between 2015 and 2024.</cite>

These are not small numbers. India has made faster progress than almost any comparable high-burden country.

But the scale of what remains is just as striking. <cite index="75-1">India accounts for 26 percent of all TB cases in the world</cite> — the highest burden of any nation. <cite index="81-1">TB incidence in India is currently roughly 1,900 to 2,000 per million people. Achieving the WHO's End TB definition of 10 per million would require a dramatic and unprecedented reduction, largely driven by prevention.</cite>

The government has since signalled a revised timeline of two to three years beyond 2025.

Why No State Has Been Certified: The Core Barriers

Drug-resistant TB remains a major drag. <cite index="77-1">India accounted for 32 percent of global multidrug-resistant (MDR-TB) cases in 2024, though incidence is gradually declining.</cite> MDR-TB — tuberculosis caused by bacteria that do not respond to standard first-line drugs — requires longer, more expensive, and more complex treatment, and is harder to eliminate from a population.

Undernutrition amplifies TB risk. TB disproportionately affects people living in poverty, and undernutrition is one of the strongest risk factors for progressing from TB infection to active disease. India's Nikshay Poshan Yojana provides ₹500 per month in nutritional support to TB patients during treatment — a scheme that has disbursed over ₹2,781 crore to approximately one crore beneficiaries since 2018. That is a meaningful intervention. But nutritional vulnerability in the population broadly remains a structural challenge that no single health programme resolves alone.

Stigma suppresses case-finding. <cite index="51-1">Stigma still prevents nearly 64 percent of symptomatic individuals from seeking early care.</cite> People with TB symptoms — persistent cough, night sweats, unexplained weight loss, low-grade fever — often delay seeking diagnosis for weeks or months, during which they can infect others. Active case-finding, rather than waiting for patients to come forward, is increasingly central to India's post-2025 strategy.

Staffing and infrastructure gaps are uneven. <cite index="55-1">While India has established over 8,295 rapid molecular testing machines to provide decentralised quality diagnostics</cite>, the density of these resources varies sharply by geography. Remote, tribal, and urban slum populations continue to have lower access to timely diagnosis.

Private sector remains partly unintegrated. India's TB burden is split between public and private health systems, with a significant share of patients first seeking care from private practitioners. Mandatory TB notification was introduced in 2012, but compliance and data quality from the private sector remain inconsistent in many states.

What India Is Doing Differently Post-2025

<cite index="57-1">After missing its 2025 target, the government rolled out a 100-day intensified campaign using around 2,000 AI-enabled handheld X-ray devices to actively screen people in high-risk villages, urban slums, prisons, old-age homes and other vulnerable settings.</cite> This shift — from passive detection to active population-level screening — is a substantive change in approach.

<cite index="50-1">Over two lakh My Bharat volunteers have come forward to serve as Nikshay Mitras</cite> — community "TB friends" who support patients through the treatment period. Community engagement at this scale is relatively new to India's TB programme and, if sustained, could help address both adherence and stigma.

The government is also piloting an additional BCG vaccination dose in adults in selected districts — an approach that has shown promise in some international contexts for reducing TB risk in older populations, though the evidence base is still developing.

[REVIEWER: add clinical insight here — e.g., from your clinical or public health experience, which of these post-2025 interventions shows the most promise for accelerating state-level progress toward certification, and what you would prioritise if advising a high-burden state government]

FAQ

Why has no Indian state achieved TB-free certification yet? India's Sub-National Certification requires an 80 percent reduction in TB incidence from 2015 levels — a bar that no state has yet crossed. India's national average decline since 2015 is 21 percent. High-burden states like Uttar Pradesh, Bihar, Maharashtra, and Madhya Pradesh face large absolute caseloads, drug-resistant TB, staffing gaps, and undernutrition that together make the 80 percent threshold extremely difficult to reach quickly.

What is India's current TB burden as of 2026? According to the WHO Global TB Report 2025, India accounts for approximately 25 percent of all TB cases worldwide — the highest burden of any country. The estimated incidence rate is 187 cases per lakh population (2024), down from 237 in 2015. TB mortality has also fallen by 25 percent over the same period. India has made the fastest incidence reduction of any high-burden country, but the absolute numbers remain large.

Which part of India has been officially certified TB-free? As of mid-2026, Lakshadweep is the only union territory with TB-free certification. Five administrative units in total — Lakshadweep, and the districts of Anantnag, Budgam, Pulwama (all in Jammu & Kashmir), and The Nilgiris (Tamil Nadu) — have met End TB targets under India's sub-national system. No full state has been certified.

What are the symptoms of TB that people should not ignore? The most common symptoms of pulmonary (lung) TB are a persistent cough lasting more than two weeks, blood in sputum, fever, night sweats, unexplained weight loss, and fatigue. Anyone with these symptoms — especially those who have been in close contact with a known TB patient — should seek evaluation at a government health facility, where diagnosis and treatment are free under the National TB Elimination Programme.

Is TB treatment free in India? Yes. Under the National Tuberculosis Elimination Programme (NTEP), TB diagnosis and treatment are available free of charge at all government health facilities. Patients also receive ₹500 per month in nutritional support through the Nikshay Poshan Yojana during their treatment period. Private-sector TB treatment is available but involves costs; TB notification to the government is mandatory from private providers.