India has over 200 million smokeless tobacco (ST) users. New ASTRA research shows that, if current policies remain unchanged, ST-related diseases will cost India over US$19 billion in lifetime healthcare spending. The National Roundtable brought together policymakers, WHO advisers, researchers, and state programme leaders who agreed on six evidence-based priorities: increase taxation, strengthen regulation, protect youth, build cessation infrastructure, train the health workforce, and decentralise strategies to local realities.