The respiratory crisis: An ominous prelude to catastrophe

Respiratory diseases, now ominously crowned as the paramount scourge of humanity, have eclipsed cardiovascular, gastrointestinal, and even oncological maladies, according to the World Health Organization (WHO). The relentless surge in morbidity and mortality, exacerbated by the pernicious effects of air pollution, widespread smoking, biomass exposure, and the inexorable march of industrialization, casts an ever-lengthening shadow over the health and economies of nations—none more so than India. India, besieged by this respiratory crisis, stands at a precipice, as an astonishing 40% of patients in clinics and hospital outpatient departments present with respiratory ailments. Even more alarming, the incidence of respiratory diseases has skyrocketed by over 200% in the last decade, as the nation teeters on the brink of a full-blown public health catastrophe.

Amidst this turmoil, two respiratory infections stand as grim sentinels of this century and the ages before it: the ancient scourge of tuberculosis (TB) and the insidious, novel coronavirus (SARS-CoV-2). India, home to the world’s highest TB burden, bears the ignominious distinction of housing 26% of global drug-resistant TB (DR-TB) cases. It is a burden so profound that it has spurred the World Health Organization (WHO) and India’s National TB Elimination Programme (NTEP) to ambitiously shift the focus from mere control to the audacious goal of TB elimination by 2025, under the banner of a “TB-Mukt Bharat.” At the heart of this Herculean mission lie the nation’s medical colleges, serving as critical citadels in the war against TB. These institutions, equipped with specialized DR-TB care under the auspices of the Department of Respiratory Medicine, stand as the front lines in treating the nation’s most vulnerable and economically disadvantaged. The 2020 National Medical Commission (NMC) directive unequivocally mandated that by their fourth renewal, medical colleges must establish robust facilities for diagnosing and treating DR-TB to ensure no patient is left behind in this national crusade.

Frontline warriors: The unsung heroes of respiratory medicine

The recent COVID-19 pandemic thrust respiratory medicine specialists into the limelight as the nation’s frontline warriors. With unyielding dedication, these experts shouldered the immense burden of managing critically ill patients in COVID-19 centres, intensive care units, and led national vaccine advocacy campaigns. Their unparalleled sacrifices and commitment were lauded at the highest echelons of power, with Prime Minister Narendra Modi and the Government of India extolling their efforts. Yet, respiratory medicine transcends pandemics; it is the linchpin of critical care, particularly for patients suffering from respiratory failure on mechanical ventilation, and it plays a pivotal role in addressing medical emergencies arising from trauma, drowning, poisoning, and industrial accidents. The indelible tragedy of the Bhopal Gas Disaster in 1984, which continues to claim victims decades later, is a chilling reminder of the paramount importance of respiratory medicine in mitigating the long-term consequences of environmental disasters.

The unraveling tragedy: The rise of chronic respiratory diseases

The insidious rise of chronic respiratory diseases (CRDs)—most notably asthma and chronic obstructive pulmonary disease (COPD)—further underscores the urgency of the respiratory crisis. Lancet’s POSEIDON study laid bare the enormity of the challenge, the burden of respiratory diseases. As the study goes, more than 50% of the patients visiting OPD have respiratory symptoms. In Delhi, where air pollution has reached unprecedented and hazardous levels, an estimated one in three residents struggles with respiratory ailments, primarily driven by poor air quality. The increase in occupational lung diseases such as pneumoconiosis, interstitial lung diseases (ILDs), lung cancer, and sleep disorders adds another layer to this burgeoning epidemic. Recognizing the magnitude of this public health emergency, these conditions have been integrated into the National Programme for Non-communicable Diseases (NCDs) under the Government’s Ayushman Bharat initiative, which seeks to provide universal healthcare coverage to the most vulnerable populations. In this context, the training of MBBS graduates in respiratory medicine is not merely important—it is indispensable for safeguarding the health of the nation.

The personal struggle: A postgraduate’s battle against MDR-TB

As a postgraduate immersed in the Sisyphean battle against the scourge of multi-drug-resistant tuberculosis (MDR-TB), I find myself at the epi-centre of a humanitarian crisis that stretches beyond mere clinical practice. Every day, I bear witness to the harrowing realities that define our public health landscape—patients, debilitated and fragile, often clinging to the last vestiges of hope as they endure the excruciating side effects of life-saving treatments like Bedaquiline, Delamanid, and Linezolid. Each case of rampant drug resistance that crosses my path is a profound reminder of the insidious grip that this ancient affliction maintains over the most marginalized and vulnerable in our society.

In this crucible of affliction, the recent decision by the National Medical Commission (NMC) to expunge Respiratory Medicine from the undergraduate curriculum is not just perplexing—it feels like a visceral blow to the very soul of healthcare. How, in a nation still ravaged by TB, where respiratory ailments form nearly 40% of all outpatient visits, can we afford to deprive future physicians of the fundamental expertise that will allow them to combat these relentless foes?

I cannot help but feel a deep sense of betrayal, knowing that this decision could jeopardize our national mission to eradicate TB by 2025. To stand in the midst of an MDR-TB endemic zone, witnessing the suffering of those who fall prey to this disease, and simultaneously be told that the future doctors who will inherit this fight may lack the essential training to rise to the challenge, is both heartbreaking and infuriating. This omission threatens not just the efficacy of our healthcare system but the lives of millions, and it calls into question our very commitment to public health.

The fight for the reinstatement of Respiratory Medicine in the MBBS curriculum is not merely academic—it is a fight for the survival of our most vulnerable. The removal of this critical field feels like an abdication of responsibility, an unforgivable lapse that imperils the health of our nation at a time when respiratory diseases are claiming lives at an unprecedented rate. As I grapple with these challenges on the front lines, it becomes painfully clear that this issue transcends individual institutions and touches the very fabric of our nation’s future.

A disconcerting development: The NMC’s controversial notification

Despite this glaring reality, a disconcerting development has sent shockwaves through the medical community. On August 16, 2023, the National Medical Commission (NMC), in a profoundly controversial move, issued a notification (Ref. No. CG-DL-E-17082023-248154) striking Respiratory Medicine/Chest Medicine/TB and Chest Diseases from the list of essential departments for undergraduate medical education. This bewildering decision has sparked a veritable maelstrom of opposition from the country’s foremost respiratory authorities. All the major pulmonary medicine societies & prominent associations of chest physicians, swiftly mobilized to challenge this decision. Urgent letters were sent to Prime Minister Narendra Modi and Union Health Minister Mansukh Mandaviya, pleading for dialogue and reconsideration. In the wake of this, delegation led by senior pulmonologists, also met with senior officials, including Shri Nitin Gadkari, the Union Minister for Road Transport and Highways, to voice their concerns. Although the political leadership has displayed sympathy, the NMC remains resolute in its stance, thus far refusing to reconsider this potentially devastating decision.

The ramifications of this decision are nothing short of catastrophic. It threatens to derail India’s progress toward TB elimination, undermine pandemic preparedness, and cripple the nation’s aspirations for Universal Healthcare. Respiratory ailments, which account for nearly 40% of all outpatient visits, require the attention of well-trained, knowledgeable medical graduates. Stripping respiratory medicine from the undergraduate curriculum would deprive millions of patients of competent care, inflicting untold suffering on the populace.

United in resolve: The fight for reinstatement

However, the nation’s chest physicians remain undeterred in their resolve. United by a shared belief in the indispensable role of respiratory medicine, they continue to fight for its reinstatement in the medical curriculum, aware that without such training, the health of millions hangs in the balance.

In a world where respiratory diseases increasingly claim more lives and cripple societies, India must not turn its back on the very discipline that stands at the nexus of survival. The fight for the soul of respiratory medicine is a fight for the future of public health, and in this battle, failure is not an option.

Legal challenges: A resilient stand

In a decisive move, respiratory medicine specialists, represented by the Indian Chest Society (ICS), have resorted to legal action by filing a Public Interest Litigation (PIL) before the Bombay High Court, challenging the exclusion of Respiratory Medicine from the MBBS curriculum by the National Medical Commission (NMC). The PIL, led by notable figures Dr. Sundeep Salvi, Dr. Raja Dhar, and petitioner Dr. Rajesh Swarnakar, underscores the criticality of reinstating the department in medical education, especially in light of the prevailing public health crisis in India.

During the recent hearing, the counsel for the petitioners, Advocate Mandlekar, advanced a compelling argument rooted in the National Medical Commission Act, 2019. The counsel highlighted that Section 16(2) of the Act mandates the Undergraduate Medical Education Board (UGMEB) to function within the ambit of the Regulations framed by the NMC, as specified under Section 57. The court was informed that the NMC, through its notification dated 28th October 2020, had identified 24 essential departments—including Respiratory Medicine, Physical Medicine and Rehabilitation, and Emergency Medicine—required for all medical institutions offering MBBS admissions.

The petitioners argued that the UG Board has no legal basis to override the 2020 Regulations, which were established under Section 57 of the 2019 Act, and urged the court to direct strict compliance with these guidelines.

Notably, during the last hearing, despite the case being listed for 04.09.2024, neither the Union of India, the NMC, nor the UGMEB made an appearance or filed any responses. In light of this, the petitioners’ counsel pressed for expedited hearings, citing the imminent MBBS admissions cycle. The bench, comprising Justices Abhay J. Mantri and Nitin W. Sambre, took cognizance of the non-appearance, issuing a stark warning to the respondents. The Court remarked:

“Needless to clarify that in case if the respondents have chosen not to file reply, this Court will draw an adverse inference against the said respondents.”

As the matter stands, as of 25th September 2025, the UGMEB board failed to make presentation before the Nagpur bench of Bombay HC. The bench did acknowledge that the matter was of national importance & needs due diligence. Fresh notice was issued to the Union of India, to be served via Hamdast (notice to be delivered physically by the petitioners).

Concluding remarks: A call to action for respiratory medicine in India

The urgent need to reintegrate respiratory medicine into India’s medical curriculum is paramount as respiratory diseases escalate to critical levels. The National Medical Commission’s removal of this discipline threatens the nation’s fight against tuberculosis and other respiratory illnesses, undermining public health initiatives. The ongoing Public Interest Litigation emphasizes the collective resolve of respiratory specialists to restore this essential training for future physicians. Unity among stakeholders is crucial; failure to equip medical graduates with expertise in respiratory medicine endangers millions reliant on competent care. As the crisis deepens, we must act decisively to safeguard the health of our nation.

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