Dr. Manisha Verma
One of the biggest killers, Tuberculosis (TB) is an infectious disease and found in every part of the world. It continues to be a major public health issue of global concern. India carries one of the largest global burden of the disease. The central and state governments are committed to ending it by 2025, five years ahead of the global target under the Sustainable Development Goals (SDG) 2030. Let us deep dive into the different aspects of the disease and understand India’s initiatives in this direction.
Global burden of TB
TB is an infectious airborne disease caused by Mycobacterium tuberculosis (M.tb). WHO estimates that nearly 1.8 billion people, accounting for close to 1/4 of the global population, are infected with TB. Approx. 13 lakh children get sick with TB each year. It is one of the leading infectious causes resulting in worldwide deaths. Last year, TB was noted to be the world’s second leading cause of death from a single infectious agent, after COVID-19. It caused almost twice as many deaths as HIV/AIDS. In 2022, 1.06 cr were infected from TB and 14 lakh died due to it. TB results in 3500 deaths on a daily basis.
Tuberculosis is strongly influenced by different social and economic and health-related risk factors. These are undernutrition, diabetes, HIV infection, alcohol use disorders and smoking. According to WHO, on the global scale in 2020, an estimated 19 lakh incident cases of TB were due to undernutrition, 7.4 lakh to HIV infection, 7.4 lakh to alcohol use disorders, 7.3 lakh to smoking and 3.7 lakh to diabetes. Although, there are regional and national variations. For instance, a high incidence is noticed among the urban population living in slums.
Thirty countries that bear a high TB burden account for 87% of the world’s total TB cases. Of these, two-thirds of the global total burden was found in eight countries.
India accounts for a large share at 27% of the total global cases followed by Indonesia (10%), China (7.1%), the Philippines (7.0%), Pakistan (5.7%), Nigeria (4.5%), Bangladesh (3.6%) and the Democratic Republic of the Congo (3.0%).
WHO commends India’s strides
The World Health Organisation (WHO) Global TB Report 2023 has credited India for its noteworthy activities and interventions towards a tuberculosis free country. WHO has appreciated India for its highly significant progress in reducing the incidence of tuberculosis by 16 per cent and mortality due to it by 18 per cent since 2015 (till 2022).
India has been commended for its intensified case detection strategies that have led to the highest-ever cases notification of cases 2022; at more than 24.22 lakh TB cases, these notifications surpassed the pre-COVID levels. A record notification was undertaken in 2023, with 25.5 lakh TB cases notified. Of these, 17.1 lakh TB cases were notified in the public sector, while8.4 lakh stood notified by the private sector. At 33% of the total notifications, this was the highest ever. The increase by more than eight times over the past nine years in the private sector notification has come through as a result of a focused and targeted engagement with the private sector through various interventions. Additionally, the treatment coverage has expanded to 80 per cent of the estimated TB cases, a hike of 19 per cent over the previous year.
In an encouraging observation, the WHO report also acknowledges that the pace of decline in India is almost double the pace at which global TB incidence is declining, which is 8.7 per cent. In addition, WHO has also made a downward revision of the TB mortality rates (from 4.94 lakhs in 2021 to 3.31 lakhs in 2022). The reduction of over 34 per cent is based on cause-of-death data for 2014-2019 collected from the sample registration system (SRS).
Key Initiatives to make India TB-Mukt
It is important to note that even though Tuberculosis is very infectious, it is entirely preventable and a curable disease when detected in a timely manner and the treatment is fully completed.
Saddled with the burden of the highest level of global TB incidence Government of India has decided to tackle the menace of TB in a mission mode. The UN and WHO have committed to end the TB epidemic. TB is part of SDG Target 3.3 which states: ‘End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases by 2030’. But Prime Minister Shri Narendra Modi announced in 2018 that India will drive out TB from the country by 2025, five years ahead of the global target. This has spurred the policy makers and the agencies working towards a TB free India to work with focussed energy. At the Stop TB Partnership meeting at Varanasi in March 2023, reaffirming India’s commitment towards ensuring a TB-free society, the PM stated that “the commitment and determination with which India dedicated itself to tackling TB after 2014 is unprecedented.”
India’s efforts are important, the PM mentioned, as this is a “new model for the global war on TB”. India’s efforts have won global accolades. Dr Lucica Ditiu, Executive Director of Stop TB Partnership, praised India’s scale in tackling TB and the TB-Free India initiative. She expressed the belief that India will end TB by 2025, and this will make a huge dent in the global TB burden.
With less than two years to for India to meet its target of being TB Free by 2025, the approach going forward is to focus on prevention of the disease and to saturate coverage of services in the detection and treatment of TB. It is encouraging to note that with continuous efforts of the governments, support agencies and the communities, the number of missing TB cases in India has reduced from 1 million in 2015 to 0.26 million in 2023.
With the goal of achieving Sustainable Development Goals (SDGs) related to TB by 2025, Union Ministry of Health & Family Welfare is implementing the National TB Elimination Programme (NTEP) with the following objectives: