Enabling effective TB control

In perspective

The figures ring out with regularity like staccato bursts of gunfire. According to the WHO Global TB Report 2016, TB was one of 10 leading causes of death and 1.8 million people worldwide died from it in 2015. By 2015, there were an estimated 10.4 million new cases worldwide and six countries contributed to 60% of the new cases. India is one of them.

In the same period, there were 4,80,000 new cases of multidrug-resistant TB (MDR-TB) and an additional 1,00,000 people with rifampicin-resistant TB (RR-TB) who were also newly eligible for MDR-TB treatment. India, China and the Russian Federation accounted for 45% of the combined total of 5,80,000 cases.

Of the estimated 5,80,000 people newly eligible for DR-TB treatment, only 1,25,000 (20%) were enrolled. Five countries accounted for more than 60% of the gap: India, China, Russia, Indonesia and Nigeria. There is a funding gap of $2 billion for TB control. It is evident that much of this funding gap will occur in these countries, and failure to close the gap will result in disastrous consequences.

As per the Census of 2011, 41% of India’s population is below 21 years old. How many of these young, productive individuals are at threat from TB? What proportion of our population will be too sick to be productive in the near future?

As Prime Minister Narendra Modi proudly ticked off India’s progress on various fronts on his recent visit to the USA, and rightly so, one was left wondering how this progress will be sustained, if more and more people fall to TB, because every infected person is capable of infecting 10 others and it does not take much intelligence to calculate how the disease will gallop.

I would like to make a personal appeal to the prime minister. “A lot of people are going to be sick very soon and therefore, unproductive. Then, the progress you outlined will slow down. A mere preventable, curable disease as TB is, would have defeated your ambitious dreams. Sir, you need to act fast if we don’t want to lag behind in this progress. You need to rid us of this scourge and allow us to move ahead without flagging on our speed.

You spoke about hastening the achievement of the UN Sustainable Developmental Goals (SDGs). The SDGs are about eradication of hunger, speeding up on education, enabling decent work, promoting sustainable cities and communities, providing for sanitation and safe drinking water among others. Achieving all these will have a direct impact on reducing the incidence of TB.

But Sir, we are behind on all these indicators and TB is winning this round. You spoke about achieving progress with speed and in the right direction. Are we going to lose to an avoidable cause, and to something that has nothing to do with terrorism, weapons and violence?

Sir, unlike other developmental problems, the problem of TB cannot be solved ground up. It needs intervention from the highest levels. It needs intervention from you because it needs vision to see that while TB can be cured, for every person cured, many more are already waiting in line, because the environment around allows for TB to spread unchecked.”

Not just medication

“Sir, we have to attack this disease with more than just medication. Unless you demand accountability on where we are with the various SDGs, and demand they be speeded up, unless you demand that all sectors work together to create an envi­ronment in India that is hostile to the spread of TB, we are going to lose sight of your vision.

The world today looks towards India for many things positive. We are emerging as a role model and a super power. The world is looking to India with hope for direction on TB as well, because it knows that we can make a difference. We are a high burden country and if we get it under control, the other countries cannot but fall in line.

Sir, we Indians are looking to you to express solidarity with the ministerial conference, “Ending Tuberculosis in the Sustainable Development Era: A Multi-sectoral Response” which is to be hosted by the Ministry of Health of the Russian Federation in November this year. This meeting will encourage WHO member states to take effective measures to end the global TB epidemic by 2030, through a multi-sectoral and interdisciplinary approach within the SD agenda.

More importantly, we need you to take the lead on the planned high level meeting that has been planned around TB for the first time by the UN General Assembly in 2018. Sir, it is your duty to own this meeting and set the agenda for TB control as our government has already committed to eliminate TB in India by 2025.

You have already set the direction. We request you walk the talk. Failure to do so would cost far too much in terms of delayed progress in India because much of our population will be sick and unable to contribute to progress.”