While the country is committed to providing access to quality healthcare through its national programmes and initiatives, India finds itself at a crossroad with one of the most infectious diseases in the world – tuberculosis (TB). The Covid-19 pandemic and the resulting diversion of healthcare resources on a massive scale has rolled back years of progress made by India in its mission to eradicate TB. This setback was further heightened by the Union Budget for FY 2023-24. Unlike its predecessor, which specifically allocated ₹36 billion for curtailing TB in the country, the latest budget makes no mention of TB or Prime Minister Narendra Modi’s declaration of having a ‘TB Mukt Bharat’ by 2025.
The world saw 1.6 million people succumbing to TB in 2021, making it the leading cause of death from an infectious disease before Covid-19 surpassed it. Out of the 1.6 million, approximately 30% of the deaths occurred in India. This is an unacceptable number of casualties from a disease that is both preventable and curable. According to the 2022 World Health Organization (WHO) Global TB report, India saw a 10% increase in TB deaths in 2021. India also saw a drop in TB case detection and reported the highest burden of TB in the world, with an estimated 2.7 million cases annually. What can be attributed to this drop-in TB care?
The pandemic lay bare the limitations of the Indian health care system. With resources diverted to tackle an unprecedented pandemic, TB diagnosis and treatment became less or least priority. Limited access to healthcare facilities and lack of established surveillance systems are a few reasons giving rise to TB underreporting.
Delays in approving newer, shorter, WHO approved regimens that can improve patient outcomes is another aspect that needs to be addressed and fastened. Additionally, knowledge of TB preventive therapy (TPT), a bedrock in eliminating TB among general public need to increase. Social stigmas also prevent persons affected by TB from seeking help and timely treatment for TB. The stigma associated with TB can compel individuals to hide the infection from fear of losing their job, their loved ones, or being kicked out of school or their homes. This severely hinders the TB response.
Financing India’s healthcare is crucial to the success of India’s ‘TB Mukt Bharat’ mission. The right funding will improve access to healthcare services, ensuring reduced wait times, accelerating diagnosis and allowing a host of counsellors to assist with the toll on mental health that this disease takes. India also has limited quality health care facilities, trained health care workers, and adequate infrastructure, which can impact the country’s ability to effectively tackle the TB problem. A well-funded health care system will safeguard the needs of the marginalised and vulnerable populations, such as women, children, and people living in rural areas.
India should also continue to invest significant funds in the development of new TB drugs and a new TB vaccine, putting the country on the cutting edge of medical science in the area. Such an investment would aim to accelerate the development of new TB treatments and a vaccine that is more effective, and more affordable than the existing options.
In Davos this year, during the World Economic Forum (WEF) annual meeting, Union health minister Mansukh Mandaviya extended New Delhi’s full support for a global plan for approving a new TB vaccine and assured that ‘India is in the advanced stage to deliver on global plan for TB vaccine by 2025.’ Such concrete actions from government and different healthcare stakeholders will ensure we’re one step closer to achieving the goal.
There has been a push for the introduction of newer and more effective initiatives such as setting up of a TB vaccine accelerator council to facilitate the use of effective novel TB vaccines by WHO.
Meanwhile the Centre, under the Nikshay Mitra initiative of the Pradhan Mantri TB Mukt Bharat Abhiyaan, has set up a platform for individuals and organisations to adopt tuberculosis patients for six months and help meet their nutritional and medical requirements.
There are civil society organisations that, through advocacy, are influencing government institutions and communities to ensure people affected by TB infection have access to TB services. This is where TB communities can play a crucial role. Like the HIV community, the TB community includes people living with TB, caregivers, health care providers, researchers, and advocates who are working together to raise awareness.
The HIV community has been instrumental in spreading awareness and advocating for their needs, leading to improvements in HIV treatment and care in India. The TB community has the potential to create a similar impact by raising awareness about the disease, advocating for better diagnostics and treatment options, and providing support to people affected by TB.
By leveraging these resources and expertise through a public-private partnership (PPP) model, healthcare stakeholders can help reduce the burden of tuberculosis in the coming years. This move is crucial for the country if it wants to achieve its TB Mukt Bharat goal by 2025. By establishing PPPs, India can strengthen its TB control programme and improve case detection, treatment success, and patient outcomes. PPPs can also facilitate the implementation of innovative solutions such as technological tools, novel drugs and diagnostics and best practices including educating the masses, eradicating poverty and removing stigma attached with TB.
To successfully combat the TB epidemic in India, the country must utilise its health care system to its fullest potential. While the task may seem daunting given India’s large population of 1.4 billion, the country has the opportunity to join the ranks of nations that have declared themselves TB-free. Achieving a tuberculosis-free India requires government institutions to address the needs of persons affected by TB through outreach efforts, surveys, and engagement. In addition, NGOs and civil society organisations should form action groups to provide a stigma-free environment for those affected by TB.
Policy makers must modify and create new TB policies to be people-centred and rights-based. It is essential for people affected by TB to be educated on their rights and access to care. By prioritising funding for health care, India can ensure that people of all age groups can live a healthy life. The country’s investments, policies, and awareness programmes can help it achieve Sustainable Development Goal 3 (SDGs) by 2025, ahead of the global deadline. With the right government, civil society and private sector support, this ambitious goal can be achieved, paving the way for a healthier, more prosperous future and making ‘TB Mukt Bharat’ a reality rather than just a slogan.
This article is authored by Mr. Vikas Panibatla, CEO, Tuberculosis Alert India (TBAI).