JOIN USIndia has made good progress in controlling tuberculosis in the last few decades but the elimination of the disease in the country is still far away. TB is a curable disease, but it continues to be a global killer and caused 1.6 million deaths worldwide in 2017. India has the highest burden of the disease among all countries, and the incidence is about 28 lakh cases every year. It causes over four lakh deaths every year. India accounted for 27% of the people developing TB in 2017 and 27% of the deaths caused by it. Other statistics about the disease in the country are also mostly negative and disappointing. On the positive side are the decline in cases of relapse and HIV+TB cases in the recent past and some control over multi-drug resistant TB. But it is a matter of serious concern that a large number of cases remain undetected.
The Lancet Commission report on TB, compiled by experts from many countries in a collaborative effort, which was released last week, gives a picture of the challenge posed by the disease and provides a roadmap for high disease-burden countries to fight it. According to the report, India’s target to become free of tuberculosis by 2025 may be unrealistic. The target of 2030 set by the UN Sustainable Development Goals may also not be achieved. If there is an efficient and well-managed campaign to eliminate the disease, the world may be able to achieve success by 2045. The weaknesses in the present strategies need to be identified and steps will have to be taken to deal with them. The report calls for more political will and allocation of more financial resources if the target has to be achieved within a generation.
In India, one major problem is the poor primary health infrastructure in rural areas in most states and the emergence of drug-resistant TB cases. Private sector participation in TB control programmes has produced results, and the report recommends scaling up of access to TB services by increasing private sector engagement. The government must enlarge the state programme through bigger allocation of resources to the health sector and within that for TB control. It is felt that India must increase its domestic spending on TB control programmes by at least 400% in the next five years and then sustain the tempo if it has to achieve the extended targets. The commission’s recommendations for better diagnostics and treatment, targeting of high-risk groups, focussing on screening and prevention and improving R&D facilities need to be given special attention in the fight against the disease.