Mission impossible: Time till 2025 too short to eliminate TB

Finance Minister (FM) Arun Jaitley’s Budget day announcement of the government’s aim to eliminate Tuberculosis (TB) by 2025 may be a tad bit too ambitious, if statistics and expert opinions are anything to go by.

According to TB India’s annual report for 2016, the incidence of TB has declined at 0.91 per cent per year over the past 24 years (from 216 to 167 per 1 lakh people). Going by the average rate of decline at present, India will eliminate TB in another 183 years, by 2197. The FM’s target to eliminate TB by 2025 entails that there should be not more than one case of TB for a population of 1 lakh. If India were to eliminate TB by 2025, the
rate of decline of cases needed is a drastic 21 per cent per year over eight years.

Lagging behind

With the current rate of annual decline of TB cases globally being 1.5 per cent, India is lagging behind in its national decline rate, says Dr Lucica Ditiu, executive director, Stop TB Partnership. “Even if the decline rates are accelerated by some percentages, elimination of TB from the face of the earth is not expected before 2100,” Ditiu says.

TB burden

World over, 96 lakh cases of TB occur every year. ‘The Tuberculosis Cascade of Care in India’s Public Sector’ — carried out by the Indian Council of Medical Research, World Health Organisation and Harvard Medical School, along with other partners — estimates 27 lakh TB cases in India. According to the latest data available, only 14 lakh TB patients are registered with the central government for treatment in 2014, while another 3.8 lakh were notified as TB-affected from private labs, clinics or hospitals between June 2014 and December 2015. “Over 10 lakh patients go missing; the government has no data about these patients,” says the lead author of the study,

Ramnath Subbaraman from Harvard Medical School.

Challenges of XDR-TB

Since 2011, there have been cases of rising instances of extremely drug-resistant TB (XDR-TB) cases in India. Indian patients have been fighting to get access to life-saving medication like Bedaquiline and Delamanid, which the government is yet to make fully available under the Revised National TB Control Programme. “Anyone who understands TB will tell you that TB elimination by 2025 is an impossible goal, especially for the nation with the world’s highest TB burden. So, the statement is rhetorical,” said Dr Madhukar Pai, professor, McGill University in Canada.

What’s needed

Unless the implementation of programmes to eliminate TB are dramatically improved, it would be impossible to control TB. The Revised National TB Control Programme’s (RNTCP) budget stood at Rs 740 crore for last year. “We require more budget allocation to execute the programme more aggressively,” said Dr Sunil Khaparde, project director, RNTCP.