An AIIMS study confirming Chinese strain-spreading tuberculosis, is a cause of concern. The Government has renewed its strategy but more needs to be done

Amid the continued din on demonetisation, the rather critical response by Minister of State for Health Faggan Singh Kulaste in Parliament may have gone unnoticed. The Minister informed the lok Sabha that a study by the All India Institute of Medical Sciences (AIIMS) has confirmed prevalence of a virus strain from China that is spreading tuberculosis in the country.

“The Government is aware about where Beijing strain of the bacteria, mycobaterium tuberculosis has been identified by doctors in AIIMS,” the Minister said last week in a written reply.

This is worrying for three reasons. First, about 1,400 people die because of tuberculosis every day — and that's a huge number. In 2015, we lost a population the size of Manchester or about 4.8 lakh people to this disease.

Second, despite best efforts of the Government and specific programmes to tackle this menace, awareness on medication remains low — a heavy dose of antibiotics which are available for free at almost all Government healthcare delivery points.

Third, unlike other big killers, which includes cancer and heart ailment, not much is being written or spoken about this silent killer. Some say that since this is a poor India's disease, there is a conspiracy of silence by media, doctors and public health experts. They attribute this silence to the intricate interplay of interests of private healthcare sector, pharma companies and the fact that unlike expensive treatment of cancer and heart ailments, the cost of curing tuberculosis is negligible and, therefore, little incentive to magnify this disease.

While it would be difficult to prove a conspiracy like this, experts have raised question mark on the private sector and practitioners for the approach they adopt on treatment and reporting of tuberculosis patients.

“Although standardised tuberculosis treatment in India is delivered by the public sector through the Revised National Tuberculosis Control Programme (RNTCP), early diagnosis and treatment are hampered by the presence of a vast and unregulated private healthcare sector.

Poor diagnostic practices in this sector prolong tuberculosis transmission by delaying diagnosis, whereas a general lack of counselling and support of treatment adherence hampers successful, relapse-free cure. Moreover, most cases treated in the private sector are not notified to public health authorities,” said a paper published by The lancet on infectious diseases.

A The New York Times report quoting Nirmala Arinaminpathy, the lead author of this paper and a lecturer at london's Imperial College, wrote: It turns out the world “had little idea of the true scale of the problem in India — the worst-affected country.”

The Global Tuberculosis Report 2016 revised new patients with tuberculosis in India to 2.8 million in 2015 as against 2.2 million in 2014 — this is more than any other country in the world, while Government reports put the figures to 1.7 million. The updated WHO estimate of tuberculosis deaths excluding deaths of HIV-positive people was 4,78,000 in 2015 and 483,000 in 2014, —that is double of what was estimated earlier.

little wonder, for the first time, and in a clear departure from previous approaches of controlling tuberculosis, the Government has asked to “end” the disease. The Government has plans to make a three-fold rise in its spending from $96 billion to $300 billion. As part of the revised RNTCP, the Government of India had in 2014 prepared the standards for tuberculosis care in India, which includes treatment, testing and diagnosis.

It also has also introduced other changes to the programme including allowing private practitioners to continue treating patients while they register for the Government's free diagnostics and drugs. Once registered, the patients are monitored by the Government, which offers home visits, counseling and screening of household members.

The Government of India has also adopted WHO's end tuberculosis strategy. With the Prime Minister’s Office monitoring the case and aiming to end tuberculosis by 2025, we do anticipate some concrete actions.

(The writer is a strategic communications professional)