Countdown Begins for TB Mukt Bharat

24th March is observed as World Tuberculosis Day in the memory of Dr. Robert Koch.

In 1883, Dr Robert Koch discovered the bacteria that causes TB. However, it took 60 years since then for the discovery of its’ cure and another 6 years to actually test it on a human patient. Since then, there have been many scientific breakthroughs to detect and cure this disease, however, it continues to haunt many developing nations as a major public health challenge. WHO has recognized TB as one of the top 10 causes of morbidity and mortality in 2019. Even though it is prevalent in Asia, Africa, Caribbean countries etc, India alone accounts for over one-third of deaths in the world. COVID-19 pandemic has only made it worse.

In 2018, Prime Minister Narendra Modi announced to make India free of Tuberculosis in 2025, which is 5 years before the SDG 2030 timelines. This was a huge commitment. To bring this to fruition, multiple stakeholders, especially the Ministry of Health, Ministry of Women and Child, ICMR, National Institute of Research in Tuberculosis (NIRT) and the States have engaged and planned to eliminate this communicable disease, but how close are we from the intended goal?

In the recent report released by NIRT, Chennai – ICMR on 25th March 2022, there are revelations and insights that policymakers working in this area must actively look into. The report indicates that a mammoth nationwide survey, targeting over 3.5 lakh people was conducted before and during the COVID pandemic. NIRT aimed to cover 625 clusters across all states of which only 448 could be covered. The BIMARU states along with Haryana, which have higher incidences than the national average, defaulted the most from the protocol with each targeting less than 60% of the intended clusters. But, to give credit where its’ due, the will to complete this survey showed the commitment of all stakeholders to eliminate TB from India.

The report contains a study on the ‘Health Seeking Behavior’ of over 3 Lakh symptomatic participants across India, which clearly shows that of the 14k people showing symptoms eligible for a sputum test, 65% did not consult for TB symptoms due to various reasons, the most alarming being “Ignored symptoms – 68%” and “Could not afford to seek care – 11%”. Even though Government of India under various programmes and schemes is provisioning for free-of-cost diagnosis and cure along with awareness campaigns in all mediums, the impact is clearly questionable.

India has done well, but time is ticking away. 2025 is not far and we are way behind in achieve the goal of eliminating TB from India. If we only talk about pulmonary TB cases, the policymakers must consider recommendations given by NIRT with respect to including X-Ray and Molecular testing for more effective detection of TB. Given the current inflation (both urban and rural) in India because of various global phenomena, Nikshay Poshan Abhiyaan scheme to give direct cash transfers to patients of Rs. 500 for 6 months each, might not meet its intended goal of improving nutrition levels. Also, research shows that the duration DOT treatment can be reduced from 6 months to 4 months in cases where the severity of infection is lower. Making detection, escalation and treatment more robust is imperative.

We need a targeted approach for eliminating TB. The targeting must be done to cater to the most infringed and untouched parts of the populations in tribal areas, as well as remote parts of India, who have a deviant lifestyle with respect to prescriptions for TB, owing to traditions, social interactions or education levels. Women and Children must be given special attention to this approach as per their nutrition needs. States which are performing ineffectively, must catalyze their efforts and align with the national mission and create real-time dashboards for transparency and public involvement. Every state must trickle down district based targets for each day.

Lastly, the most vital means is awareness. Effective messaging should be given utmost importance to hammer the gravity of the situation in the minds of all sections and sub-sections of India, especially the states where the curative health infrastructure is in tatters. Early detection for better response should be one of the mantras going forward. Simultaneous capacity building for health infrastructure and awareness programmes to nudge people to take the tests will catalyze detection and give a better picture for conceiving subsequent mitigation strategies.

If we wish to make India ‘TB Mukt’ as early as possible, we take the right steps in the right direction. This cannot be done by Government alone as seen in the reports as well, support from private sector and Civil Soceity Organizations are a must. With ongoing research for easier solutions and a potential one-time vaccination for TB elimination underway, it is not an impossible dream but a tedious one at that.