India accounts for 27 per cent of the global TB burden of 1.04 crore new cases every year (which is 28 lakh Indian patients) and 5,22,000 (29 per cent) of 18 lakh global deaths
A new research paper published in British Medical Journal has called Union Government’s declaration of ending Tuberculosis by 2025, extraordinarily ambitious.
India accounts for 27 per cent of the global TB burden of 1.04 crore new cases every year (which is 28 lakh Indian patients) and 5,22,000 (29 per cent) of 18 lakh global deaths. Further, it accounts for 76,800 (16 per cent) of the estimated 4,80,000 new cases of multi-drug resistant TB.
“While high-level political commitment is welcome and necessary, the real question now is how India can go from rhetoric to real progress?” Asks Madhukar Pai, lead author of the paper and professor at McGill University in Canada.
DNA was the first to report on February 3, that India’s TB elimination target for 2025 is tad bit too ambitious, considering the year-on-year rate of decline of cases over the past 24 years (216 to 167 per lakh) is a mere 0.91 per cent. Going by this statistic, it may take 183 years for the scourge to wean off. If TB were to be eliminated by 2025, the rate of decline would have to be 22 per cent year-on-year, a huge jump from the annual rate of 0.91 per cent.
Another Lancet article says, “As another World Tuberculosis Day (on March 24) passes by the outlook for TB control is far from optimistic, especially for India, the ground zero for the global epidemic.”
The BMJ paper offers a slew of suggestions which may aid India eliminate TB. In February 2017, the Revised National Tuberculosis Programme (RNTCP) published a draft of a new National Strategic Plan (NSP) for TB Elimination 2017 - 2025. “The cost of implementing the new NSP will be $2.5 billion, a significant increase over NSP 2012 - 2017. Contradictorily, if analysis is anything to go by, the funds available for RNTCP could be lower, at a time when new NSP aims for TB elimination, says the paper.
Major gaps were identified in the cascade of care study, done in collaboration with Union Health Ministry and WHO, which said that close to 50 lakh patients reach public health facilities but are either not successfully diagnosed or not started on treatment. To address these gaps, the paper says, RNTCP will have to be modernised. “India relies heavily on antiquated approaches, including smear microscopy, intermittent drug regimens and paper-based reporting. In order to improve the system, India will have to scale up rapid molecular diagnostics, more widely accessible daily drug regimens, combined with tools for adherence support,” said Dr Pai.
“TB elimination by 2025 is an impossible goal, especially for the nation with the world’s highest TB burden,” said Dr Pai. —The Lancet
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