This week, Union Health Minister Mansukh Mandaviya restated the Government’s commitment to working towards a TB-free India by 2025. How plausible is this ambition?
“[The] Government and people will work together to make India TB-Free by 2025,” the Minister told lawmakers in the Rajya Sabha. He emphasised the need to raise awareness of tuberculosis as a core component of this effort, as well as addressing risk factors for the condition such as poverty and malnourishment.
“[The] time has come to end deadly diseases in this country,” Mandaviya said. “We need to make collective efforts to win against TB. Poverty and malnutrition are two main reasons for TB. Elected representatives need to ensure steps for the eradication of the disease.” He touted the efforts by the Narendra Modi administration, stating “we had never linked health with development. Under PM Modi’s leadership, the definition of health has been comprehensive. In the coming days, India will achieve its target of making the health sector more robust.”
Vice president M. Venkaiah Naidu, who chairs the Rajya Sabha, echoed Mandaviya’s sentiments. “If all the local, central, and state governments, MPs, and officials join together and make it a people’s movement, it won’t be difficult to eliminate TB by 2025,” he said.
The lofty goal of eliminating tuberculosis and moving to a TB-free India by 2025 is not a new one. Last year, Dr Harsh Vardhan – Mandaviya’s predecessor as Minister of Health and Family Welfare – rearticulated the aim. “By 2025, we wish to eliminate tuberculosis from India,” he said. Similarly, Union Finance Minister Nirmala Satharaman reiterated the Government’s commitment to a TB-free India by 2025 in her Union Budget.
Elimination of TB in India by 2025 is five years in advance of global targets, but it is clear that the country has a long way to go. India accounts for 27 percent of the global TB burden and 31 percent of mortality due to the disease. Eliminating the disease is an effort fraught with challenges. Diversion of resources due to the COVID-19 pandemic has seen a decline in screening for tuberculosis – a worry given TB patients are more susceptible to contracting the novel coronavirus.
Last year, Health Issues India reported on the effects of the pandemic on efforts to combat TB. One study found that the current gap in care resulting from the COVID-19 pandemic carried the potential to lead to an additional 6.3 million cases and 1.4 million deaths from tuberculosis by 2025. The Union Health Ministry has not identified a rise in cases due to the COVID-19 pandemic, but acknowledged the need to scale up screening efforts earlier this year.
“Due to the impact of COVID-19-related restrictions, case notifications for TB had decreased by about 25 percent in 2020 but special efforts are being made to mitigate this impact through intensified case finding in OPD [outpatient department] settings as well as through active case finding campaigns in the community by all states,” the Government said.
A further challenge is the rise in drug-resistant cases of tuberculosis, of which India accounts for more than 25 percent of global cases. The fact that the COVID-19 pandemic is fuelling drug resistance adds to concerns, especially when it comes to the fight against TB. As we previously noted
“Many diseases such as tuberculosis have already developed resistance against many first line antibiotics. These strains are becoming ever more common, making the disease far more difficult — and expensive — to treat. Previous studies have estimated that…strains that are resistant to almost all currently used medications — will account for 8.9 percent of TB cases by 2040, compared to just 0.9 percent in 2000. This is particularly worrying, as a high prevalence of XDR-TB [extremely drug-resistant tuberculosis] will make eradication efforts almost impossible without the development of new medications.”
Furthermore, in April, “research found that one million fewer children received the Bacillus Calmette–Guérin vaccine that prevents severe tuberculosis. Extrapolating this data across the COVID-19 pandemic, several million may have missed a vaccine that is vital in bringing TB under control. Should diseases be neglected for any further amount of time, India could soon be facing many more issues once COVID-19 has been brought under control.”
India is behind on its efforts to control tuberculosis. The aim of a TB-free India by 2025 is as admirable as it is ambitious, but efforts must be multisectoral and cohesive to realise this ambition. Mitigating the damage and disruption of the COVID-19 pandemic to TB control efforts is vital. It is not an insurmountable challenge, but it is not one to downplay. Lofty targets are one thing – but the absence of action will see millions pay the price.