As per 2019 data from the World Health Organisation (WHO), India is estimated to have close to 2.64 million TB cases. (File photo: IE)By Dr K Madan Gopal and and Suryaprabha Sadasivan
In the past year, the Covid-19 pandemic has taken the center stage of all public health discussions, decisions, and interventions, and rightly so! With the roll-out of vaccination, increased thrust on Covid-19 testing coupled with mask and hand hygiene-related behavioral shift, the situation seems more manageable today. And this allows us to reshift our focus on critical public health priorities such as tuberculosis (TB).
As per 2019 data from the World Health Organisation (WHO), India is estimated to have close to 2.64 million TB cases. Recently, Prime Minister Modi outlined his aim to eliminate TB from the country by 2025. In line with this vision, the National Tuberculosis Elimination Programme (NTEP) was launched in 2017 with a funding of over Rs. 12,000 crores to ensure access to quality diagnosis, treatment, and support. Eradication of TB will not only mean a decline in cases and deaths but also the elimination of the socio-economic burden of this disease. The rate of decline has been around 1.5-1.8 percent since 2017, which is not enough to realize India’s aspirations of eliminating TB by 2025.
Over the decades, significant progress has been made towards tuberculosis control in India. Last year, the Government of India launched an accelerator campaign to the National Strategic Plan – “TB Harega Desh Jeetega” which focused on improved advocacy and communications, stronger inter-ministerial collaboration, and lastly, better engagement and participation from the private sector, communities, and other relevant stakeholders.
However, despite all these initiatives and enhanced commitments, in recent years, one of the most formidable barriers to the elimination of this deadly disease are missing cases, which are potential for spreading infections and the ever-increasing drug resistance of about 3-5 percent of new cases and 14-20 of the old cases. This has hugely impacted prevention and care, making it challenging to treat patients and thereby resulting in poor health outcomes.
As per experts, if India wants to end TB by 2025, the rate of decline of incidence of TB needs to be more than 20% per year over the next 5 years. In the advent of drug-resistant TB, this effectively means that India not only has to aggressively continue its efforts to prevent and cure TB but also committedly work on the mitigation of antimicrobial resistance (AMR).
According to WHO, nearly 700,000 people die every year due to AMR of which, more than 230,000 people die due to multi-drug resistant (MDR) TB. It is estimated that AMR could be responsible for as many as 10 million deaths per year by 2050 across the world. Tackling the double burden of TB and AMR is no mean feat.
As stated in the “Vision 2035 Public Health Surveillance in India” report by NITI Aayog, one of the most crucial steps to ensure sustainable use of antibiotics and to mitigate the risks of resistance, is the creation of a robust surveillance system. By strengthening the laboratories to collect quality data, substantial inputs could be generated to improve the National Strategic Plan for TB control and AMR National Action Plan created by the Government.
Also, there is a need for a stronger thrust on the One Health approach for AMR management wherein, stakeholders from farming, veterinary, medical, and environmental sectors need to collaborate and commit to best practices that reduce the spread of AMR in India. There exist several gap areas that continue to pose a threat – from overuse, and misuse of antibiotics, indiscriminate use of antibiotics in poultry and farming practices to improper pharma effluent disposal, and untreated hospital waste.
There is a need to improve access to diagnostics and treatment support, engage with the private sector to further strengthen the healthcare system and TB surveillance efforts. It will be important to better optimize the services provided by tuberculosis laboratories to strengthen antimicrobial resistance diagnostic testing and surveillance. Through enhanced integration of resources, optimization of funding streams, there is an increased likelihood of achieving mutual goals.
India’s National Strategic Plan for TB Elimination as well as the National Action Plan-AMR, aim to improve health outcomes against infectious diseases and to limit the spread of drug resistance. As we move forward to realize the country’s TB elimination vision, it will be critical to focus on the convergence of efforts through improved inter-ministerial coordination, stronger commitment from the actors in the ecosystem – corporates, communities, farmers, hospitals, and medical centers among others. The collective effort demonstrated during the Covid-19 times makes this quite possible and is truly a reflection of cooperative federalism which we have been talking about.
The columnists are Senior Consultant (Health), NITI Aayog and Suryaprabha Sadasivan, Vice-President, Chase India.
Disclaimer: Views expressed in this article are personal.
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