While India improved case detection for TB and was able to cover the losses which took place during the pandemic, in this regard it missed major milestones. By the way India, accounts for the highest TB burden across the world by contributing 27% of all the TB cases followed by Indonesia (10%) and China (7.1%). The present report of 2023 gives figures on various indicators of TB for 2022.
For any country’s TB eradication programme, a major challenge is not to miss the cases and see to it that the majority of cases are registered or ‘notified’. A patient getting missed is not only harmful for the individual concerned but also her contacts as she might spread the TB infection to them. So, every year the governments all over the world try to increase notification of new cases and close the gap between estimated TB incidence and vis-a-vis the number of cases which are newly notified.
According to the WHO report, Philippines, India, and Indonesia, which jointly accounted for a large share of the global reductions in the warning of newly identified cases in 2020 and 2021 all of them recovered to above 2019 levels in the year 2022.
A press release issued by the Union health ministry on the evening of the 8th of November also pointed out the achievement and said that, India reversed the impact of COVID-19 on the TB programme.
WHO reports that, as many as 13 countries, including India, which reported major case detection reductions in 2020 and 2021 rebounded to 2019 levels. However, the report also put a caveat to this achievement and its understanding.
As far as year 2022 was concerned, the WHO reported, 10 nations continue to account for more than 70% of the cases missed. India was the top contributor to this share as it accounted for 18% of such cases. It was followed by Pakistan, Philippines, Indonesia and Nigeria.
From a global perspective, efforts to increase levels of case detection are of specific importance in these countries. The report noted that, highlighting the significance of improved diagnostic tools.
Incidentally, the WHO, 2018, had come up with some interim TB targets to be achieved so as to eradicate the world’s top killer by 2030. The temporary targets are known as first ‘End TB Strategy’ milestones.
The press release said India could lessen the TB-related deaths by 18% in 2022 as compared to 2015 levels – almost at par with global reduction levels of 19%. However, this achievement is way too far off the mark.
The WHO’s target was to lessen TB-related deaths from 2015 to 2025 by 75%. Going by the present pace, most of the countries, including India, will most likely miss this goal as well.
Drug-resistant TB remains to be a major concern for the world
Resistance to rifampicin – the most effective first line drug against TB – is of utmost concern, conferring to the WHO. The form of TB that is resilient to rifampicin and isoniazid is defined as multidrug-resistant TB (MDR-TB). Both MDR-TB and rifampicin-resistant TB (RR-TB) needs treatment with second-line drugs, which is not only very expensive, prolonged but also leads to many other direct and indirect consequences.
Generally, a patient may become resistant to the first line of drugs during the course of TB treatment due to missing drug doses either due to stock-out of drugs or improper adherence to the medicine schedule. Some of the newly-diagnosed TB cases could also be that of DR-TB, as a resistant form of infection got transmitted from an infected DR-TB patient to a healthy person.
Also read: Watch | TB Patients Across India Struggle With Acute Drug Shortages, Govt Denies but WHO Worried
The WHO in 2021 issued updated guidelines for diagnostics. It recommended that quick molecular tests should replace the tradition sputum microscopy tests as the former have high diagnostic accuracy and help in early detection of TB or to understand if the patient is resistant to a drug.
The present TB report mentions that, in India, less than 20% of all the notified cases were detected through the WHO-recommended molecular kits against the least target of 80%. This target was achieved by 55 countries
Expenditure on health, which is incurred out-of-pocket by patients’ households on their own, is a major warning in fights against all illnesses, including TB. If more than 10% of the annual household income is spent on treatment of any kind of sickness, the WHO describes it as “catastrophic health expenditure”.
The WHO, in its present report also did a downward revision of TB mortality figures for India which was published in last year’s global TB report. Government’s press release alluded to the “newer evidence” that the Indian government shared with the WHO after the publication of its report. The WHO stated that it revised the figures owing to the new cause-of-death data that came from the country’s sample registration system.
According to the present report, in 2022 3,42,000 TB patients died in India.
