July 12, 2026
Can we ever end tuberculosis (TB) –
the deadliest infectious disease on Earth – without ensuring
that every single person who takes an initial TB test
receives a truly effective one? A test that accurately and
rapidly detects active TB disease. A test that misses no
one. Because finding TB early and accurately is not optional
– it is the indispensable lynchpin, the non-negotiable
gateway to the entire treatment and care pathway.
“If
we miss people with active TB disease due to a poor test,
then we fail to reduce avoidable human suffering and risk of
TB death. More worrying is that the infection keeps
spreading,” said Prevent-Find-Treat ALL TB campaign leader
Shobha Shukla. “There is no excuse for inaction since WHO
recommended portable molecular tests are available since
2010. We must eliminate deadly delays between scientific
breakthroughs and the time by when they translate into
public health impact.”
As per the latest WHO Global TB
Report 2025, almost half (46%) of the TB patients in 2024
worldwide received a poor test – microscopy. Microscopy
misses finding TB accurately in half (or more) of those who
take this test. It is being used since last 144 years ago
when Dr Koch made this TB scientific breakthrough. But in
the last two decades, science has gifted us some highly
sensitive and specific portable molecular tests to find TB
early and accurately – and quite a few of these are WHO
recommended.
That is why the highest-level leadership
of the UN health agency – World Health Organization (WHO)-
had called upon the governments (Find.Treat.All) in 2018 to
completely replace microscopy with upfront WHO recommended
molecular tests by 2027.
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Prior to this, Government of
India’s National TB Elimination Programme had released its
National TB Elimination Strategy 2017-2025 under the
visionary leadership of the then-head (Deputy Director
General) Dr Kuldeep Singh Sachdeva. This strategy had also
set forth an ambitious time plan to radically scale up
upfront molecular TB testing in India during 2017-2025.
Indian government programme has surpassed several of the
indicators enlisted in that strategy.
In 2023, world
leaders of 193 countries unanimously adopted the Political
Declaration to end TB at United Nations General Assembly
High Level Meeting. This Political Declaration also
re-echoed the promise to replace microscopy completely with
WHO recommended molecular test as an upfront or initial TB
test by 2027.
Few days ago, a sign-on of ‘Bangkok
Declaration’ is circling around on social media that is
asking people to sign in their ‘personal capacities’ to
replace microscopy with upfront molecular testing for TB by
2028. This supposedly came out from a meeting funded by
Gates Foundation and organised by Stop TB Partnership on
near point-of-care TB tests in Thailand. But the ‘Bangkok
Declaration’ does not mention who organised it.
This
29 words Bangkok Declaration reads as follows: “We commit,
in our personal capacities, to a phased replacement of smear
microscopy with WHO-recommended molecular testing for the
initial diagnosis of tuberculosis, to be completed by
2028.”
It is absolutely undeniable what this Bangkok
Declaration states – “to phased replacement of smear
microscopy with WHO-recommended molecular testing for
initial TB diagnosis.” But we do not agree with the timeline
of 2028 – because we can do better now!
Why shift the
2027 goalpost?
With around 1 year 5 months left to
deliver on 2027 TB targets enshrined in the Political
Declaration endorsed by all world leaders unanimously in
2023 at UNHLM, why should we shift the goalpost on TB
testing by a year? Ensuring that the first initial or
upfront TB test is a molecular test is a non-negotiable when
it comes to TB disease elimination strategy by
2030.
This is very doable too as most countries have
significantly rolled out upfront molecular testing
worldwide. For every one US$ invested in TB prevention and
control, there are health and economic returns of US$ 43.
So, TB investment is a smart investment too.
Deadly
gap
As per the latest WHO Global TB Report 2025,
globally, 54% of all TB patients notified in 2024 were
diagnosed with an upfront molecular test. In African region,
53% of all TB patients notified in 2024 were diagnosed with
an upfront molecular test. This number dips to 41% for
Southeast Asian region though.
38% of all notified TB
patients in India, 56% in South Africa, 65% in Indonesia,
69% in Nigeria, and 74% in Philippines got an upfront
molecular test in 2024.
It is evident that since some
years now, different countries are at different stages of
replacing microcopy with upfront molecular test TB
diagnosis.
100% upfront molecular TB testing
for high TB risk homeless and migrant populations is
possible, then why not for everyone else?
In
India – a country with highest TB burden – and in Delhi
state – a state with the country’s highest TB incidence, the
government TB elimination programme in partnership with
Humana People to People India was able to achieve 100%
upfront molecular test diagnosis among populations at very
high TB risk: homeless and migrants.
When we can
achieve 100% upfront molecular testing in high risk
populations in Delhi, then why cannot we ensure this for
everyone else? Best time to do the right thing was years
back – second best time is now.
There are more
examples: Goa state in India had completely
replaced smear microscopy with upfront molecular test TB
diagnosis 5 years ago. Lakshadweep, a Union Territory in
India, had also achieved 100% upfront molecular test
diagnosis and recently was declared TB free. Dr Rakesh PS, a
noted TB elimination consultant presented at AIDS 2026
Affiliated Independent Event on the theme: Rethink, Rebuild
and Rise to Put People First and deliver on ending AIDS and
TB in next 54 months (by 2030). Dr Rakesh PS shared that
there were months every year when 10 of the inhabited
Lakshadweep islands were very difficult to reach due to
rough sea or bad weather. TB diagnostics was decentralised
with WHO recommended molecular test in each of the 10
islands. Better technology alone is not enough but designing
public health systems that respond to local realities of the
people they serve is critical. Taking services closer to the
communities was a game changer along with empowering local
health workers to lead the response.
In the past five
years, Stop TB Partnership’s introducing new tools project
had also rolled out artificial intelligence enabled handheld
ultraportable X-Rays along with portable battery-operated
molecular test Truenat and demonstrated strong impact in
terms of finding TB early and accurately – and helping save
lives.
The uncomfortable question is why were
these high impact interventions not taken to scale, with
urgency and immediacy?
So asked Sumit Mitra,
a noted thought leader on bridging the deadly diagnostic
divide in the Global South, who was also among the key
speakers at AIDS 2026 Affiliated Independent Event hosted by
over 30 organisations collectively with Prevent-Find-Treat
ALL TB campaign, CNS and UNAIDS.
All is not so bleak
as there is hope too – again from a country with highest TB
burden – India. Indian government’s National TB Elimination
Programme which was then-headed (DDG) by Dr Urvashi B Singh,
made a foundational shift in how it finds TB on 7 December
2024. AI-enabled X-Rays and portable molecular test were
supposed to be taken in a van (Ni-Kshay Vahan) to high-risk
communities and offer them TB screening and test closer to
their homes. In first 100 days, government’s programme found
over 285,000 asymptomatic people with active TB disease –
none of them would have been found so early if such an
approach was not driving the TB case finding. Dr Urvashi B
Singh was speaking at AIDS 2026 Affiliated Independent
Event.
India’s health minister told on World TB Day
2026 that in one year, Indian government could find over 1
million (10 lakhs) asymptomatic people with active TB
disease – none of them would have been found so early if
such a science-based approach was not driving the efforts.
Early and accurate TB case finding is critical to prevent
the spread of infection as well as link people to lifesaving
TB treatment, care and support.
Unless we use
the right TB test and stop missing TB cases among those who
take a TB test, how will we ever eliminate
TB?
Most strategic advocacy demand should not
be to shift the 2027 goalpost but instead call for rapid
scale up of upfront molecular testing as soon as possible –
and latest by end of 2027 as promised by world leaders at
the 2023 General Assembly.
The latest update to WHO TB
Diagnostic Guidelines around World TB Day 2026 was an
important turning point as, among other important
recommendations, it also recommended near point-of-care
portable molecular test (30 minutes TB test).
The list
of WHO recommended molecular tests is expanding but the pace
at which these tests are being rolled out on the ground is
not matching the public health emergency and crisis which TB
has posed against us historically.
Bridge the gap: No
one should remain unreached
As per the latest WHO
Global TB Report 2025, there were an estimated 10.7 million
people worldwide with active TB disease in 2024, but
four-fifth of them were diagnosed and linked to care.
One-fifth (2 million) is the global gap between those we
reach and we need to reach to find ALL TB and link them to
lifesaving care.
In 2024, in African region, out of
estimated 2.6 million people with TB disease, 1.9 million
were notified. In Southeast Asia region, out of 3.7 million
estimated people with TB disease, 3.1 million were
found.
In the same year, out of 2.7 million people
with TB, 2.5 million were notified. Out of 249,000 people
with TB in South Africa, 183,000 were notified. Out of
510,000 people with TB in Nigeria, 402,000 were notified.
And out of 724,000 people with TB in Philippines, 544,000
were notified.
Unless we reach ALL people with active
TB disease early and diagnose ALL of them accurately, and
link ALL of them to standard TB treatment, care and support,
how will we end TB?
Infection prevention remains
cornerstone. No one should get infected with a disease that
is preventable.
Person-centred, rights-based access to
TB services is an essential bedrock
TB diagnostic
technology alone is not enough. Most essential is to ensure
that health and social support services of the government,
including those for TB, are person-centred, rights-based and
gender transformative. We need to dismantle social,
structural and systemic barriers people face in accessing
health and social services. When populations – who are
most-at risk of TB – are able to access public services with
equity, safety and dignity, then only a real change will be
possible in helping save lives from an ancient disease like
TB.
Shobha Shukla, Bobby Ramakant –
CNS (Citizen News Service)
(Shobha Shukla is the
founder Managing Editor of CNS (Citizen News Service) and
leads Prevent-Find-Treat ALL TB campaign. Bobby Ramakant
works with CNS. Follow them on X: @shobha1shukla,
@bobbyramakant)
– Shared under Creative Commons
(CC)
