TB: Effort does not match ambitious goals

India’s efforts to reduce incidence of TB have stalled in the last few years

The TB India 2023 report released by Prime Minister Narendra Modi recently shows that the country’s targets for reducing the incidence of tuberculosis and fatalities due to it are far from being achieved. A national plan in 2018 had aimed to bring down the incidence of TB to 142 per one lakh population but it was 194 in 2020. The goal for TB mortality rate also has not been achieved. While the plan was to bring it down to 15 deaths per lakh population in 2020, it came down only to 23. The incidence and mortality figures for 2022 are 196 and 23 respectively. These figures indicate that the Prime Minister’s announcement at the recent OneWorld TB Summit that the country was committed to eliminating TB by 2025 is unrealistic. Even the WHO goal of elimination of TB by 2030 looks very daunting.

The country has made much progress in the fight against TB, but it still faces serious challenges. India accounts for over 30% of all TB cases in the world. The incidence at 196 cases per lakh population in 2022 is good progress from the 2015 figure of 256 but there may be questions even about the count. Many cases in rural areas and among the poor may have escaped notice. The missed numbers would not be small because the incidence of TB is more in rural areas and among the poor. Women patients also escape notice. Targeted testing has shown that more women suffer from TB than men, but official figures show their numbers to be far fewer than of men. If there are problems in the identification of patients, treatment and remedial measures also need improvement. The infrastructure and facilities for treatment are inadequate, especially in rural areas. Primary healthcare is poor in many states.

Studies have shown that many people do not go for treatment even when they have symptoms of the disease. Going for self-medication has been found to be common. Treatment regimens are lengthy and many people stop it midway. This leads to more complications. The incidence of tuberculosis has a social and economic dimension also because many patients are from the poorer and backward sections of society. Most of them do not have access to nutrition which is needed to support treatment of the disease. There are other challenges like resistance to drugs. Some drug-resistant strains of TB are not amenable to treatment and the affected patients pass on the disease to other people. There are few facilities for isolation of such patients. Therefore, the new goals for dealing with the disease need to be supported by better efforts than seen till now.