Tuberculosis, commonly referred to as TB, has a significant global presence with the World Health Organisation (WHO) reporting an estimated 10 million new cases globally in 2017. A staggering 2.74 million of these cases were reported from India alone, exhibiting a marginal reduction from the 2.79 million reported in 2016. These staggering figures reflect the high burden of TB on the Indian population.
The United Nations Sustainable Development Goals (SDGs) aim to end the TB epidemic by the year 2030 as outlined under Goal 3. India, however, has set its sights on eliminating this epidemic five years ahead of the UN’s goal i.e., by 2025.
| Country | TB Incidence(2017) | TB Mortality(2017) |
|---|---|---|
| India | 2.74 Million | 410,000 |
| Indonesia | 842,000 | 98,000 |
| China | 889,000 | 41,000 |
Lancet Commission Report: An Overview
The Lancet Commission on Tuberculosis, in its report titled ‘Building a Tuberculosis-Free World’, used modelling for three high-burden countries – India, Indonesia, and China, and compared it with data from 2015. The report estimates that a significant reduction (57% in incidence and 72% in mortality) will only be seen by 2045.
The report labels India’s goal of eradicating TB by 2025 as “ambitious,” “unrealistic,” and, therefore, unattainable. The primary reasons for this include the high prevalence of TB cases in India (204 cases per 100,000 individuals in 2017), a lengthy patient delay before the first presentation for care (4.1 months), and the fact that up to 10% of individuals with TB die or self-cure before presenting for care.
Moreover, there’s the continuous threat of multidrug-resistant TB (MDR-TB), with India having the highest number of such cases globally. Thus, early diagnosis and prompt initiation of effective treatment should be a high priority to curb MDR-TB transmission.
Recommendations from the Lancet Commission
The report emphasizes the need for integrating TB services within the primary health system for early diagnosis and cutting the transmission cycle. It also recommends strengthening the ‘care cascade’, which visualizes problems related to the implementation of ‘treatment as prevention’. This could potentially reduce cumulative TB incidence by 38% in India’s case.
Even though India has made significant progress in its fight against TB, the report suggests that further improvements in diagnosis and treatment for drug-sensitive and drug-resistant TB are essential. By subsidizing tests and supporting patients in completing their treatment, the lives of around eight million (28%) people with TB can be saved over the next 30 years. This would cost an additional $290 million each year, far less than the country’s annual TB-induced losses of $32 billion.
Furthermore, India needs to adopt measures to prevent TB on a population level to eliminate the disease in the coming decades. This includes scaling up access to TB services for all those seeking them, optimizing the engagement of private sector healthcare providers, and guaranteeing universal access to drug susceptibility testing and second-line TB drugs.
The National TB Control Programme: Opportunities and Challenges
The Lancet report also acknowledges that India’s National TB Control Programme shows promise. It notes the political will dedicated to controlling TB, and that accountability is a vital component of achieving this goal. However, despite the programme identifying all the necessary initiatives to manage the disease, implementing them remains a persistent challenge.
In 2018, India reported 2.15 million TB cases, reflecting a 16% increase from 2017. The private sector reported 0.54 million of these cases, which marked a substantial 35% increase from 2017.
The National Strategic Plan for TB Elimination (2017–25) aims to increase private TB reporting to two million patients per year by 2020. To achieve this, it is imperative to have close coordination between the Ministry of Science and Technology, Ministry of Health, and research-oriented pharmaceutical companies. Further, case-finding campaigns have been undertaken to avoid waiting for people with TB to reach diagnostic centres for testing.
Moreover, it is essential to acknowledge the high out-of-pocket expenditure incurred during TB treatment, which leaves people impoverished for up to seven years post-treatment.
About The Lancet and Tuberculosis
The Lancet is a globally recognized British medical journal known for its peer-reviewed papers and in-depth analysis.
Tuberculosis (TB), caused by the bacteria Mycobacterium tuberculosis primarily affects the lungs. It is both curable and preventable but is spread from person to person through the air. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that don’t respond to standard anti-TB drugs. However, it’s treatable using second-line drugs.
Unfortunately, more severe forms of MDR-TB like Extensively Drug-Resistant TB (XDR-TB) exist, which are caused by bacteria unresponsive to the most effective second-line anti-TB drugs. This leaves patients without any further treatment options. In 2017, high TB burden countries accounted for a whopping 87% of new TB cases globally, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. The World TB Day is observed annually on March 24th.