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High Time to End Tuberculosis

The time to act is now if we want to eradicate tuberculosis by 2030.

he global burden of tuberculosis is in decline. However, previously known as “consumption,” is still the deadliest
with an estimated 10 million new cases of tuberculosis infectious disease in the world, with patients and their families
and 1.6 million dying from the disease globally in 2017, we facing stigma and incurring devastating socio-economic costs.
still have a long way to go. A centuries-old disease, tuberculosis, The United Nations’ first-ever high level meeting on tuberculosis,
8 octoBER 6, 2018 vol lIii no 40 EPW Economic & Political Weekly

held on 26 September 2018, has committed to accelerating efforts If there is no consistent follow-up of treatment regimens and
and increasing funding towards achieving the agenda of the outcomes, tuberculosis patients can easily slip through the cracks,
Sustainable Development Goals to end the tuberculosis epidemic resulting in cases of relapse, and multidrug-resistant (MDR) and
by 2030. India, which accounts for 27% of the world’s tuberculosis extensively drug-resistant (XDR) tuberculosis. Further, while
burden, had set its own target at the End-TB Summit in Delhi treatments have been successful in 69% of the reported cases,
earlier this year: TB Free India by 2025. Considering the state of in the cases of MDR tuberculosis, only 46% report successful
India’s healthcare, this may be an unrealistic target. treatment. The coverage and prophylactic treatment of vulnerable
The under-reporting of tuberculosis cases has been a perpet- populations, such as children under five living in households
ual issue hampering efforts at estimating, controlling and treat- with tuberculosis and HIV/AIDS patients, has been even slower.
ing the disease. Of the 10 million estimated cases worldwide, With an estimated 1.7 billion or 23% of the world’s population
the number of cases actually reported is only 6.4 million, and having latent tuberculosis infection, it is important to take steps
India alone accounts for 26% of the 3.6 million global gap in the to prevent the spread of the disease in vulnerable populations
reporting of tuberculosis cases. Though the number of reported and the emergence of new cases from this pool. Of the five risk
cases from India has seen a jump since 2013, largely attributed factors for tuberculosis mentioned in the World Health Organi-
to increased reporting from the private health sector, the under- zation’s Global Tuberculosis Report 2018—alcohol, smoking, dia-
reporting of tuberculosis cases that have been detected and the betes, HIV/AIDS, and undernutrition—it is undernutrition that
under-diagnosis of the disease itself make a treatable and cura- poses the gravest risk in India, as it does in other poor, developing
ble disease like tuberculosis deadly and rampant. nations, especially among children. The prevention and suc-
In 2012, when it declared tuberculosis a notifiable disease, India cessful treatment of tuberculosis is closely linked with the over-
had set up “Nikshay,” an online tuberculosis reporting system for all improvement in nutrition and health indicators, poverty, and
medical practitioners and clinical establishments, with the aim access to healthcare. Further, the data on the disease with
to increase the reporting of tuberculosis, especially from the private which we are working in India is more than 60 years old now,
sector. In the years since it was launched, Nikshay has faced many with the last national-level survey on tuberculosis having been
roadblocks on the ground, such as unawareness of the system, un- conducted in 1955. Regular national-level surveys can help
willingness to report due to misconceptions about it, inconsistency countries plan their disease control and prevention programmes
in reporting, and lack of incentives for those reporting cases. better. India is slated to carry out such a survey only in 2019/2020;
Though the private sector has begun notifying cases—when earlier hence, it will be a few years before we can start working with
there had not been any reporting on its part—Nikshay’s adoption more reliable data, rather than just estimates.
and use has been slow, unlike countries such as China that have Considering the deadly and epidemic nature of tuberculosis,
been able to more effectively lower the incidence rate of tuberculo- the development and spread of new methods and technologies
sis after putting in place similar online reporting mechanisms. In to detect the different modes of this disease, new vaccines, and
March 2018, in a gazette notification, the Indian government put new drugs and shorter drug regimens have been slow, as com-
in place provisions penalising the non-reporting of tuberculosis pared to other such diseases like HIV/AIDS. It was only after 40
cases, along with making it mandatory for pharmacists/chemists years that two new drugs to treat MDR tuberculosis, bedaquiline
to report tuberculosis cases and maintain records of the drugs and delamanid, were recently made available. Also, the develop-
dispensed to patients, allowing for self-reporting by tuberculosis ment of a vaccine for preventing the emergence of the disease in
patients, and providing cash incentives to those reporting cases. vulnerable and adult populations is sorely required. The research,
The challenge is to use this system consistently and persistently, development, trials, and the actual use of new methods and
as is the treatment regimen for the disease. While the reporting of drugs take years, decades even. Unless the global community
cases has increased, the corollary reporting on treatment outcomes acts now, with India and other tuberculosis-affected countries at
has not been robust. In 2016, of all the tuberculosis cases noti- the forefront, the 2030 target to eradicate tuberculosis will be
fied, the treatment outcome data for 22% had not been reported. far from attainable.

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