On March 24, World TB Day, Prime Minister Narendra Modi in a series of tweets said that the Centre and the state governments are working together to make India TB-free by 2025, five years ahead of global target of achieving the goal in 2030.According to the Global TB report 2017, a quarter of the world’s Tuberculosis cases are in Indian which is estimated to be around 2.8 million.
“Today, on World TB Day we reaffirm our commitment towards ensuring a TB-free society. This would greatly benefit the poor. Correct and complete treatment is the key to winning the battle against TB. I also salute the people and organisations strengthening the TB-free movement,’ read one of the tweets.
However, a recent report published by British medical journal, Lancet, a tuberculosis-free world is possible only by 2045, 15 year after the target year set by the United Nations Sustainable Development Goals (SDGs) to end the epidemic. One of the co-author’s of the report called India’s goal to end the epidemic by 2025 too “ambitious”, “unrealistic”, and unattainable.
“Eliminating TB by 2025 is a laudable vision, but difficult to achieve, considering the complexities of managing the situation, which requires equitable high quality of care to every person from diagnosis to treatment, cutting the transmission rapidly with a combined strategy of early diagnosis treatment of latent tuberculosis infection (LTB) and improving socioeconomic conditions,” said Nalini Krishnan, one of the co-authors.
According to the World Health Organization’s “Global Tuberculosis Report 2018″, 27% of the 10 million people who had developed TB in 2017 were in India. India also makes up 32% of global TB deaths among HIV-negative people. Eric P. Goosby, part of the UN’s special envoy on TB, said private sector engagement in disease erdication might help speed up the process and save lives. “In India, optimizing private sector engagement could avert eight million deaths between now and 2045. In addition to the lives lost, even with optimal implementation of all existing tools, unavoidable deaths will cost the Indian economy at least $32 billion each year for the next 30 years.”
Goosby also said that as the world becomes more inter-connected, India has a greater burden of to eradicate TB as quickly as it can. “Ending TB in India will have massive global impact in addition to saving the lives of tens of millions of India’s people over the next 25 years,’ he said.
The report also argues that the existing treatment is not enough to save lives as even if present treatments were extended to 90% of people with TB, and 90% were successfully cured, they still would have failed to stop 800,000 TB deaths in 2017.“Global research investment needs to increase by up to four times (from US$726 million in 2016) to develop treatments and prevention tools that would transform TB outcomes” says the report. Some states, however, have seen some relief from government’s schemes. The central government’s direct benefit transfer (DBT) scheme for tuberculosis (TB) patients has covered 56 per cent of total patients in Maharashtra in a bid to provide better nutrition.
Even as current treatment gets questioned, new drugs have been been successfully tested in the country, especially in fighting drug-resistant TB. Bedaquiline and delamanid, has been found to be safe and effective in a small groups especially to paediatric and adolescent patients who have shown consistent sputum conversion (samples testing negative for the bacteria) and overall improvement after being on the combination of the drugs.
Apart from more investment and better treatment procedures, Indian TB patients also suffer from the unique issue of stigma around the disease which deters the patients to receive continued care which is vital to curing the disease. Last year, REACH, an organisation working on TB since 1998, initiated the first ever Legal Environment Assessment of TB in India, an exhaustive exercise to understand how TB interacts with the law and with human rights. Survivors of TB especially young women are often thrown out of their homes by husbands and families while children with TB get isolated in school. Discrimination by healthcare workers at health facilities in both the public and private sectors is also quite common.
Compiled by MUSKAAN SHARMA
(With inputs from The Indian Express, The Hindu and The Mint)