India can convert this pandemic into an opportunity by meeting health challenges and establishing its position as a global leader in combatting TB
The COVID-19 pandemic has foregrounded the urgent need for infection control and strengthening of health systems to mitigate the risk of spreading all deadly diseases, not just the current pandemic. The Indian Government has been trying to stem the spread of the Coronavirus by screening those coming into the country and also those who have come in contact with people exhibiting symptoms of COVID-19 infection. It has also been tackling misinformation regarding the outbreak. This is crucial, for there are many instances where misinformation has caused panic.
However, while the world has shown exceptional solidarity in coming together and collaborating for a cure and vaccine for COVID-19, we still have an ancient disease — tuberculosis (TB) — that continues to wreak havoc especially in an overpopulated and developing country like ours.
TB has claimed more lives than any other infectious disease in history and it has struck back with a vengeance killing 4,000 and infecting 30,000 people every day across the globe. In India, as many as 1,600 people perish daily because of TB and we carry 28 per cent of the global burden, the highest in the world today. Between 2006 and 2014, the direct and indirect economic impact of the disease was nearly $350 billion.
TB adversely affects the human resource development, productivity and well-being of our nation. About 70 per cent of the patients are between the age group of 15-54. The disease results in an average loss of 40 per cent of the annual household income. It disproportionately affects the poor and the marginalised, often pushing families into vicious debt traps and poverty.
Social determinants like hygiene, sanitation, under-nutrition, migration, unplanned urbanisation, haphazard proximal living spaces, social discrimination, stigma and the emergence of drug resistance TB have further aggravated its management. Despite all efforts, we fail to identify nearly one million cases every year.
The Global Coalition Against TB (GCAT) is working to raise the level of discourse by promoting dialogue between policymakers, civil society, practitioners, domain experts and other stakeholders.
Sustained advocacy has contributed enormously to policy initiatives, such as the banning of outdated serological tests, making TB a notifiable disease, establishing the a National TB Research Consortium, providing social support for patients, using of Information and Communication Technology (ICT) tools to track adherence, enhancing private sector engagement and conducting advocacy for mechanisms to track progress.
GCAT participated in major global conferences, recognising that the cross-pollination of ideas, sharing knowledge and learning from proven interventions and innovations promote outcomes significantly.
The Government has done phenomenal work under the Revised National TB Control Programme (RNTCP) since its inception in 1997, having treated nearly 18 million people and achieving globally-acceptable detection and treatment rates. Even though RNTCP is most likely the world’s largest anti-TB programme, the Government’s outreach has its limitations and there are large gaps in the system, since nearly 68-70 per cent of the people are treated in the private sector.
In 2018, India hosted the ‘End TB’ summit, where the Prime Minster made a commitment to the global community to end TB in 2025, five years ahead of the deadline under the United Nation’s (UN) Sustainable Development Goals (SDGs). Our federal Health Minister also made similar assurances during the one-day special session on TB in the UN General Assembly (UNGA) in 2018.
Under the Revised National Strategic Plan, the Government also announced the allocation of $1.8 billion for the period 2017-2020 and the deployment of 1,300 advanced molecular diagnostic machines and expansion of use of ICT. The Government must continue to integrate the private sector productively and build on the models of public-private interface and successes of project ‘JEET’ (Joint Effort for Elimination of TB).
JEET is an inspiring example of collaborative effort between the Government, international agencies and diverse civil society groups working together to set-up multi-sectoral review mechanisms, improve compliance with standards of TB care besides promoting awareness and education. The Government must aim to provide adequate molecular diagnostic machines at the grassroots level that would entail tripling the existing 14,000 microscopic centres. India has the largest pool of local governments in the world (2.5 lakh) right down to the panchayat level. These institutions can be leveraged to promote awareness and educate communities to counter social discrimination and stigma associated with TB. If we have to abide by the SDGs and liberate our country from this dreadful epidemic, we have to continue to build partnerships and alliances, step up research and development, create a strategic vision backed by strong political will, promote technology, innovation and indigenous solutions and engage the local communities. We can get inspiration from success stories of smaller countries like Cambodia, Peru and Estonia. India can convert this crisis into an opportunity by meeting these challenges and positioning itself as a global leader.
(The writer is president, Global Coalition Against TB)