Eliminating tuberculosis (TB) in India by 2025 – Explained, pointwise

Introduction 

India has set an ambitious target to eliminate tuberculosis (TB) by 2025, five years ahead of the global target. The government, scientists, entrepreneurs and the community at large are working towards achieving this goal. Despite being the largest contributor to global TB cases, India has seen a decline in the number of cases in 2021, with improvements in reporting and a reduction in drug-resistant TB cases.  

What is Tuberculosis (TB)?  

Tuberculosis (TB) is an infectious airborne bacterial disease caused by Mycobacterium tuberculosis. It most commonly affects the lungs but can also damage other parts of the body.

What is the current status of TB?  

In the decade between 2010-20, 1.5-2 million individuals died every year because of tuberculosis. TB disproportionately affects people in low-income nations, the poor and the vulnerable. According to WHO’s Global TB report 2021, with 25.9 lakh TB cases, India is home to 25% of the global tuberculosis cases. India has reported more than 20% decline in case notifications. The country reported 18 lakh tuberculosis cases in 2020 as compared to 24 lahks in 2019.  

What is the need for Eliminating TB earlier in India?     

Eliminating TB earlier in India is crucial for a number of reasons, including:  

Health: TB is a major cause of illness and death in India, and eliminating the disease would significantly improve the health and well-being of the population.  

Economic impact: TB has a significant economic impact, as it can lead to loss of income and productivity for individuals and families. Eliminating TB would reduce this impact and help to boost the economy.  

Poverty reduction: TB disproportionately affects people living in poverty, and eliminating the disease would help to reduce poverty and promote economic development.  

Global health: TB is a global health concern, and eliminating the disease in India would contribute to the global effort to control and eventually eliminate TB.  

Sustainable Development Goals: Eliminating TB is an important target under the United Nations’ Sustainable Development Goals (SDGs), and achieving this goal in India would contribute to overall progress towards the SDGs.  

Social justice: Eliminating TB would help to promote social justice by reducing the burden of the disease on vulnerable and marginalized populations, such as those living in poverty or with limited access to healthcare.  

What are the global efforts taken to reduce the incidence of TB?  

What are the government’s steps for Eliminating TB in India?  

India has implemented a number of steps to eliminate tuberculosis (TB) as a public health problem in the country. Some of the key measures are:  

Strengthening the healthcare system: The government has increased healthcare facilities, employees, and TB diagnosis instruments. The government has increased access to more accurate molecular diagnostic tests like CB-NAAT and TureNat. The government has also implemented a universal drug susceptibility test, meaning that antibiotic susceptibility of the mycobacterium is determined for all newly diagnosed cases.  

Improvements in treatment protocols: Injectable kanamycin, which caused kidney failure and deafness, has been replaced by Bedaquiline and Delamanid. These new pharmaceuticals have also been included in the new National List of Essential Medicines, giving the government the authority to control their market pricing.  

Recently, the government also rejected U.S. pharmaceutical giant Johnson & Johnson’s (J&J) attempt to extend its monopoly on the manufacturing of the anti-tuberculosis drug Bedaquiline in India beyond July 2023.

Implementing the Revised National Tuberculosis Control Program (RNTCP): The RNTCP is a national program that provides free diagnosis and treatment for TB patients. The program has been expanded to cover the entire country.  

Use of GeneXpert technology: The government has introduced the use of GeneXpert technology, which allows for rapid diagnosis of TB and drug-resistant TB.  

Engaging with private healthcare providers: The government has engaged with private healthcare providers to improve the quality of TB care and ensure that TB patients receive appropriate treatment. 

Targeting high-risk populations: The government has targeted high-risk populations, such as people living with HIV/AIDS, migrants, and those living in poverty, to improve TB diagnosis and treatment. An online Ni-kshay portal has been set up to track the notified TB cases.  

Target setting: The national strategic plan 2017-2025 sets the target of India reporting no more than 44 new TB cases or 65 total cases per lakh population by 2025. It also aims to reduce the mortality to 3 deaths per lakh population by 2025. The plan also aims to reduce catastrophic costs for the affected family to zero.  

Promoting TB awareness: The government has launched public awareness campaigns to promote the importance of TB prevention, diagnosis, and treatment.  

Adopting a patient-centric approach: The government has adopted a patient-centric approach to TB care, with a focus on providing patient-friendly services and improving patient outcomes.  

Community engagement programme: The government launched the community engagement programme where Ni-kshay mitras can adopt TB patients and provide them monthly nutritional support.  

What are the challenges in Eliminating TB in India?  

High burden of TB cases: India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022. This makes it difficult to identify and treat all cases in a timely manner.  

Drug-resistant TB: India has a high burden of drug-resistant TB, which is more difficult and costly to treat than regular TB. Inadequate use of antibiotics and poor adherence to treatment regimens have contributed to the emergence of drug-resistant strains.  

Limited access to healthcare: Many people in India, particularly in rural areas, do not have access to quality healthcare facilities or cannot afford to seek medical care. This can result in delays in diagnosis and treatment, and may also lead to the spread of TB.  

Stigma and discrimination: TB is still stigmatized in India, and many people are reluctant to disclose their illness or seek treatment due to fear of discrimination or social isolation.  

Poor living conditions: Overcrowded living conditions, poor sanitation, and lack of access to clean water can increase the risk of TB transmission.  

Limited awareness: Many people in India are not aware of the signs and symptoms of TB or the importance of completing the full course of treatment. This can lead to delays in diagnosis and treatment and contribute to the spread of TB.  

Insufficient funding: Despite being a major health problem in India, TB often receives insufficient funding and attention from policymakers and healthcare providers.  

What should be done for eliminating TB in India?  

Implement a comprehensive TB control program: The Indian government should develop and implement a comprehensive TB control program that includes early diagnosis, effective treatment, and follow-up care.  

Expand access to healthcare: Efforts should be made to expand access to healthcare facilities, particularly in rural areas where access is limited.  

Increase funding: TB prevention and treatment should be a priority for the government and policymakers, and funding should be increased to support research, prevention programs, and treatment efforts.  

Targeted prevention programs: Programs aimed at preventing TB in high-risk populations, such as healthcare workers, people with HIV, and people who are homeless, can help to reduce the overall burden of the disease.  

Increase public awareness: Public awareness campaigns can help to increase knowledge of TB symptoms, transmission, and prevention. This can be done through mass media, community outreach, and social media.  

Reduce stigma and discrimination: Efforts should be made to reduce the stigma and discrimination associated with TB. This can involve working with community leaders, healthcare workers, and affected individuals to promote acceptance and understanding. 

Improve living conditions: Efforts should be made to improve living conditions, particularly in overcrowded and impoverished areas, to reduce the risk of TB transmission.  

Invest in research and development: Investment in research and development can help to identify new diagnostic tools and more effective treatments for TB. For example, The recent development of artificial intelligence software for detecting hot spots in the lungs from digital chest X-rays is a promising tool for mass active case finding of TB in the community.  

Collaborate with other countries and organizations: Collaboration with other countries and international organizations can help to share best practices, knowledge, and resources for TB control.  

Sources: Indian Express, Business News, CNBC

Syllabus: GS 2: Social Justice – Issues relating to development and management of Social Sector/Services relating to Health