Global logistics disruptions raise concerns over TB drug supply in India

Logistics disruptions triggered by geopolitical tensions in West Asia are affecting shipments of tuberculosis medicines and diagnostics, prompting global health agencies to warn of possible delays in supplies to high-burden countries, including India.

The Global Drug Facility (GDF) of the Stop TB Partnership, which procures and distributes TB medicines and diagnostics globally, said this week that disruptions to air and maritime transport routes in the region are affecting shipment routing, transit times and transportation costs for deliveries between manufacturing hubs and distribution centres.

According to the organisation, several international cargo routes between Europe, India and Africa traditionally pass through major West Asian aviation hubs. With airlines reducing or rerouting operations and some shipping lines adjusting services in the region, cargo shipments are increasingly being rerouted through alternative hubs, potentially extending transit times.

The GDF said it is prioritising urgent shipments and working with logistics partners and freight forwarders to minimise logistical delays and prevent treatment interruptions in countries dependent on global TB medicine supply chains.

Against this backdrop, a survivor-led advocacy network in India has written to the Union health ministry seeking clarification on the continuity of anti-TB medicines and diagnostic supplies under the National TB Elimination Programme (NTEP).

Survivors Against TB (SATB), a national network representing people affected by tuberculosis, has written to the Ministry of Health and Family Welfare asking whether the programme anticipates any disruption in the availability of anti-TB medicines and diagnostic consumables used for testing and treatment.

India runs the world’s largest tuberculosis treatment programme under the NTEP, providing free diagnosis and medicines through the public health system. The country accounts for roughly 25% of the global tuberculosis burden, according to the latest World Health Organization’s Global TB Report. India notified approximately 2.62 million tuberculosis cases in 2024, according to the most recent data from the Union health ministry and WHO, making it the country with the highest TB burden.

The scale of the challenge

The government had set a target of eliminating tuberculosis by 2025, five years ahead of the global Sustainable Development Goal timeline of 2030. While the target drove a major expansion of screening and treatment programmes, the country continues to carry the largest caseload even as the original deadline has passed.

Under the National TB Elimination Programme, patients diagnosed with tuberculosis receive free anti-TB medicines, diagnostics and treatment support through government facilities and a network of private providers linked to the programme. According to government programme data, more than 2.6 million patients are placed on TB treatment each year, including thousands receiving therapy for multidrug-resistant forms of the disease.

Recent academic research has also highlighted vulnerabilities in TB medicine supply chains. A study published in the Indian Journal of Immunology and Respiratory Medicine in the February 2026 edition cited “irregular supply chains” and “inadequate drug exposure” as contributing factors to rising drug-resistant tuberculosis cases.

Past reports have occasionally flagged stock-outs of certain tuberculosis medicines or diagnostic consumables in some states, often linked to procurement or distribution delays as the programme expanded access to newer therapies. However, the Union health ministry has maintained that there is no nationwide shortage of anti-TB medicines, stating that the NTEP maintains buffer stocks and central procurement mechanisms to ensure continuity of treatment.

Shift to newer TB treatments

In recent years, India has increasingly adopted newer oral regimens for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, replacing older injectable therapies.

These regimens rely on medicines such as bedaquiline, delamanid, pretomanid, linezolid and clofazimine, which have improved treatment outcomes and reduced the toxicity associated with older treatment approaches. Newer combinations such as BPaL and BPaLM, recommended for highly drug-resistant tuberculosis, have been standardised under the programme.

However, the supply chains for several of these medicines remain globally interconnected.

Pretomanid, used in the BPaL regimen, is developed by the non-profit product development partnership TB Alliance and manufactured through licensed pharmaceutical partners.

Similarly, bedaquiline, originally developed by Janssen, part of Johnson & Johnson, is supplied through a combination of global procurement mechanisms and licensed generic manufacturing arrangements. Indian pharmaceutical companies also play a significant role in the global TB drug supply. Companies such as Macleods Pharmaceuticals, Lupin and other generic manufacturers produce several first-line and second-line TB medicines supplied both to India’s national programme and to international procurement agencies such as the Global Drug Facility.

Securing medicine supplies

Under the NTEP, TB medicines are procured centrally through government tenders and distributed through a national supply chain network. The programme also maintains buffer stocks of medicines and diagnostic consumables to reduce the risk of treatment interruptions.

In its letter, SATB has sought clarification on the current supply outlook for TB medicines and diagnostic consumables, the level of buffer stocks maintained under the programme, and the mitigation measures in place if disruptions arise.

For patients undergoing treatment for multidrug-resistant and extensively drug-resistant TB, therapy can last six months to over a year, and interruptions in medicine supply during treatment can lead to treatment failure and increased drug resistance. “For people undergoing MDR/XDR-TB treatment, which can last many months, any interruption in treatment can have serious consequences, including treatment failure and amplification of drug resistance,” the network said.

Diagnostic consumables used in TB testing systems are also critical to the programme, as delays in testing can slow treatment initiation. “Transparent communication and preparedness planning are essential to protect the health and confidence of those currently undergoing TB treatment,” the network added.