World Tuberculosis Day: Urgent Actions, Quick Reduction Of Death Rates Needed To End TB In India By 2025, Expert Says

Tuberculosis is a disease caused by a bacterium called Mycobacterium tuberculosis, which usually attacks the lungs, but can attack any part of the body such as the kidney, spine and brain.

Prime Minister Narendra Modi had set a target to end tuberculosis by 2025, which is five years ahead of the world's target to end the disease as a public threat.

World Tuberculosis Day is observed every year on March 24 to commemorate the date in 1882 when German physician Dr Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis.

What is tuberculosis?

Tuberculosis is a disease caused by a bacterium called Mycobacterium tuberculosis, which usually attacks the lungs, but can attack any part of the body such as the kidney, spine and brain. People infected with TB who do not get sick are said to have latent TB infection (LTBI). 

The aim of World Tuberculosis Day is to educate the public about the impact of tuberculosis around the world, and raise awareness about the devastating health, social and economic consequences of the disease and to step up efforts to end the global tuberculosis epidemic. 

The theme for World Tuberculosis Day 2023 is 'Yes! We can end TB'. The theme aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new recommendations by the World Health Organization (WHO), adoption of innovations, accelerated action, and multisectoral collaboration to combat the tuberculosis epidemic, the WHO says on its website. At the 2023 UN High-Level Meeting on TB, experts aim to raise visibility and political commitment on tuberculosis. 

Decline in tuberculosis rates in India

According to the Global TB Report of the WHO, tuberculosis rates in India have declined by one-fifth between 2015 and 2021, and death rates from the disease have also reduced by around seven per cent in the country, during the same period. This year, the Global TB Summit is being held in Varanasi, India, on World Tuberculosis Day. 

India aims to eliminate tuberculosis by 2025

Prime Minister Narendra Modi had set a target to end tuberculosis by 2025, which is five years ahead of the world's target to end the disease as a public threat.

“India’s ambitious mission to eliminate TB five years before the global target is commendable. About 10-15 years back, there were only a few national reference laboratories to test for drug-resistant TB. Now, the country has such diagnostics in every district which is a major leap forward,” Dr Ishwar Gilada, Consultant in HIV and Infectious Diseases and Secretary General of People’s Health Organization (PHO), told ABP Live.

Emphasising on the fact that Indian pharmaceutical companies have also made significant contributions in supplying life-saving tuberculosis medicines within the nation and globally at affordable prices, Dr Gilada said that recently, an Indian company reduced the prices of molecular tuberculosis diagnostics, which is a “welcome step”. 

Many people have drug-resistant tuberculosis, which is a condition in which the person with tuberculosis is resistant to at least isoniazid and rifampin, the two most potent tuberculosis drugs. However, over the past decade, the number of people with drug-resistant tuberculosis who get diagnosed and treated has increased, Dr Gilada said.

Dr Gilada also appreciated India’s leadership in tuberculosis research, and stated that several clinical studies, including those on potential tuberculosis vaccines, are in their final stages. The results of these studies may be released this year at the National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR).

Dr Gilada said that India has demonstrated leadership in scaling up access to tuberculosis prevention, diagnostics, treatment and care like no other country in the world, through its domestic capacity to produce and supply the best tuberculosis medicines and diagnostics.

“Despite these important successes, we need much stronger actions with a sense of urgency and purpose if we are to end TB by 2025 in India,” Dr Gilada said.

Tuberculosis rates need to decline more steeply than the current rate

He explained that tuberculosis rates need to decline many times more steeply than the current rate of annual tuberculosis decline, and tuberculosis deaths also need to reduce quickly.

“We need to remember that TB is a preventable and curable disease, and even one death is a death too many. Every new case of TB infection is a grim reminder of what we could have averted if infection control measures were more effective – including treating latent TB infection,” Dr Gilada said.

National Tuberculosis Elimination Programme

According to a statement released by PHO, several initiatives under the National Tuberculosis Elimination Programme of the Government of India have shown promising results. The PHO said that the public-private partnership model of the programme is very effective and must be emulated by other programmes such as the National AIDS Control Programme (NACP).

Unison Medicare and Research Centre is the only private sector entity in South Mumbai that is recognised by the National Tuberculosis Elimination Programme. People can access the latest medicines such as bedaquiline at the centre.

However, the PHO said, there is a need to approve more private healthcare services so that they can effectively contribute towards the elimination of tuberculosis.

Many people with tuberculosis are still subject to social stigma, especially multidrug-resistant tuberculosis. 

Tuberculosis accounted for over half-a-million deaths in India in 2021

Tuberculosis is the deadliest infectious disease in India, and accounted for over half-a-million deaths in 2021. Covid-19 is the deadliest infectious disease worldwide, and has caused half-a-million deaths over a period of three years. 

About three million new cases of tuberculosis were reported in India in 2021. Of these, 54,000 were people living with human immunodeficiency virus (HIV). 

Of the total number of tuberculosis deaths that occurred worldwide in 2021, 38 per cent were reported in India. About 11,000 people who died due to tuberculosis in India that year were living with HIV.

According to PHO, tuberculosis is the biggest cause of death among people living with HIV. 

“This is unacceptable because we can prevent, diagnose and treat TB – even among people living with HIV,” Dr Gilada said. 

Also, in order to end tuberculosis, it is important to focus more on children, the younger people, and the elderly. This is because one out of every 10 persons in India with tuberculosis in 2021 was under 14 years of age, and one out of every five persons with tuberculosis the same year was above 55 years of age. 

According to the PHO, one-third of these elderly persons could not get access to tuberculosis services, or were not notified to the National Tuberculosis Elimination Programme. People can break the chain of infection transmission through optimal infection control practices at homes, communities and healthcare facilities. 

People with tuberculosis must be treated with a combination of medicines they respond to. Due to drug-resistant tuberculosis, medicines have become ineffective. 

About 1,19,000 new cases of multidrug-resistant tuberculosis were reported in India in 2021. Less than half of these people received treatment. 

According to recent research on tuberculosis, all-oral treatment of drug-resistant tuberculosis can be much safer, shorter and more effective than the old treatment method of administering tuberculosis patients with injectables for two years.

New medicines such as bedaquiline, pretomanid, and delamanid have been proved to be safe and effective by recent research. 

Some combination regimens include bedaquiline, pretomanid and linezolid (BPaL); and bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM). BPaL is still in pilot mode in India. 

Another issue faced by people worldwide is the lack of access to tuberculosis diagnostic kits.

“Best diagnostic tests should be free and easily accessible to those who need it everywhere - to detect TB disease as well as to which drugs a person may be resistant to,” Dr Gilada said.

This will ensure that effective treatment can commence without any delay.