India’s Union Health Budget 2026-27 and the release of the country’s first evidence based lung cancer guidelines have sparked important conversations about whether our health system is keeping pace with global standards. These announcements are not just policy milestones – they are litmus tests of whether India can deliver care that is equitable, affordable, and responsive to the realities of patients. As someone living with Stage IV ALK positive lung cancer, I see these measures not as abstract reforms but as choices that directly shape survival, dignity, and hope.

Budget Signals but Gaps Persist
The Bio Pharma Shakti scheme, with a ₹10,000 crore outlay, signals India’s ambition to become a hub for biologics and targeted therapies. If implemented well, this could mean more indigenous research and clinical trials for lung cancer, so patients are not forced to travel overseas to access life saving innovation. The focus on mental health and geriatric care is welcome, and training one lakh allied health professionals could ease the burden on doctors and improve patient care.

For people with cancer, customs duty exemptions on 17 drugs will reduce treatment costs modestly. Yet the omission of Lorlatinib, the most effective ALK inhibitor with superior brain metastasis control, is glaring. India imports hundreds of oncology molecules, and exemptions on a handful, scratch the surface of affordability.

Meanwhile, public insurance schemes like PM JAY still exclude targeted therapies and immunotherapy – the backbone of modern cancer care. For most families, this means catastrophic spending or abandoning treatment altogether. Customs duty relief without insurance coverage is like offering a lifeboat without fixing the holes in the ship.

Guidelines Risk Lagging Behind Global Standards
The National Evidence-Based Guidelines for Lung Cancer Treatment and Palliation released by the Department of Health Research earlier this month remain fairly generic. They do not do justice to the full spectrum of oncogene driven Non-Small Cell Lung Cancer (NSCLC), i.e., cancers caused by specific genetic mutations such as EGFR, ALK, RET, ROS1, MET, and KRAS. These mutations act like “switches” that drive cancer growth, and each requires a different therapy to turn the switch off.

India’s guidelines predominantly focus on EGFR‑driven cancers which are the most commonly diagnosed in the country (around 25-30% of NSCLC cases). But this narrow emphasis risks sidelining other oncogene‑driven cancers such as ALK (~5% of NSCLC cases) and ROS1 (~1-2% of NSCLC cases), along with RET, MET, and KRAS.

These subgroups may be smaller in proportion, but they are far from irrelevant. ALK and ROS1 mutations disproportionately affect younger, non‑smoking patients – often in their 30s and 40s – who are breadwinners for their families and at crucial points in their lives. Each of these mutations defines a distinct treatment pathway, and ignoring them risks leaving patients invisible in national policy.

Global guidelines treat these subgroups as distinct, with clear recommendations for testing and targeted drugs as first‑line care. India’s guidelines, however, risk promoting a one‑size‑fits‑all approach that ignores the lived realities of patients who depend on precision oncology for survival.

Prevention and Screening: Still Narrow
Screening remains one of the most cost effective tools in cancer control, yet India’s national program is limited to breast, cervical, and oral cancers. Lung cancer is now the leading cause of cancer deaths worldwide, and colorectal cancer is rising rapidly in India, particularly among younger adults. Despite this, there is no systematic screening for either disease.
The consequences are devastating: patients are often diagnosed late, when treatment is more complex, more expensive, and less effective. For lung cancer, where survival depends on early detection, the absence of screening programs is especially cruel. For colorectal cancer, which can often be prevented through early detection of polyps, the lack of screening means missed opportunities to save lives.

Chronic Underinvestment in Health and its Social Determinants
Year on year, the health budget has increased in absolute terms. But as a percentage of GDP, public health spending continues to stagnate at 1.6-1.8% – far below the National Health Policy, 2017 target of 2.5% and global averages of 4-6%.

Source: https://ourworldindata.org/grapher/public-health-expenditure-share-gdp?country=JPN~IND~BRA~CHN~ZAF~THA

India’s figures pale in comparison, underscoring how chronic underinvestment perpetuates inequities: patchy diagnostics, unevenly delivered primary health care, inadequate infrastructure, and unaffordable therapies.

Of course, India’s health budget suffers not only from under allocation but also under utilisationdue to administrative bottlenecks. This double failure – too little money, and too little use of what is available -- perpetuates inequities and undermines trust in the system.

Even more troubling is the pollution control budget, which has been cut in the latest Union Budget. In previous years, the limited funds that were allocated were significantly underutilised, leaving critical interventions unimplemented. This is a travesty, because air pollution is one of the leading risk factors for cancer – including oncogene driven subtypes like ALK positive lung cancer, which I live with. For people like me, the failure to invest in pollution control is not an abstract policy gap; it is a direct assault on our survival.

A Call for Conscience
As someone diagnosed with lung cancer at 35, I know what invisibility feels like. Young adults with lung cancer are rarely represented in trials, and Indian patients remain underrepresented in global research. Survivorship is not just about living longer; it is about living without financial ruin, with dignity, and with systems that recognize our voices.
Cancer care is not only a fiscal responsibility – it is a moral one. Duty exemptions are welcome, but they must be paired with systemic reforms: stronger primary care, equitable insurance coverage, investment in prevention, and mandatory reporting of every cancer case. The burden of cancer falls disproportionately on those least able to pay. Without deliberate policies to reduce inequities, fiscal measures risk benefiting only a fraction of patients.

India has the scientific talent, the pharmaceutical capacity, and the patient voices to lead globally. The months ahead will determine whether the Union Health Budget and the country’s first lung cancer guidelines become turning points or missed opportunities. Cancer does not wait for GDP targets, and patients cannot wait for promises to turn into action.

Urvashi Prasad is Senior Fellow, Pahle India Foundation; Executive Director, ALK Positive India; and Former Director, Office of Vice Chairperson, NITI Aayog.