Learnings from the pandemic, if appropriately applied, could also help us get back on track faster
This year’s World Tuberculosis Day, on March 24, was yet another grim reminder of the depth of COVID-19’s collateral damage on non-COVID health issues like TB. But some learnings from the pandemic, if appropriately applied, could also help us get back on track faster.
The stats are daunting. TB was the world’s leading infectious killer until it was displaced by COVID-19. After years of hard-won progress, 2020 saw the first increase in TB deaths since 2005, as well as a 15 percent reduction in the number of people treated for drug-resistant TB.
India bears the highest burden of TB cases, accounting for 26 per cent of global incident TB cases in 2020. And to compound the damage, a HaystackAnalytics report estimates that 65 per cent cases reported are in the most economically productive population segment of 15-45 years.
Tackling TB and wresting back control will have to be a multi-pronged effort. One of the biggest learnings from the COVID-19 pandemic was the key role of early diagnosis, and in that sense, the scaled-up diagnostics infrastructure is already being repurposed for TB diagnosis. Dr Jitendra Singh, Minister of State (Independent Charge) for Ministry of Science and Technology & Earth Sciences, has already referred to the formation of a Genome Sequencing Consortium for Whole Genome Sequencing TB surveillance, which will allow doctors to prescribe the right medication based on the exact strain of TB infecting a patient. This is one of the key steps to preventing and arresting the development of multi drug resistant (MDR) TB, which is already very high in India.
As per the India TB Report 2022 released on World TB Day, in 2020 and 2021, there was a reduction of 14 per cent and 9 per cent in the number of MDR patients put on treatment as compared to the estimated numbers. Similarly, higher reductions were also seen in the number of XDR-TB patients being started on treatment in 2020 and 2021 as compared to the previous years, and also against the estimated numbers.
The report points out that reversals in progress in the number of people enrolled on MDR/ XDR-TB treatment means that the gaps have widened to reach the targets set at the UN high-level meeting and National Strategic Plan for Elimination of Tuberculosis (NSP 2017-25).
While recommending steps to be explored and implemented for early diagnosis and decentralised delivery of DR-TB services, aimed at reversing this trend, the report lists strategies such as provision of rapid molecular diagnostics of TB to everyone or to high-risk patients upfront (accessibility) and an integrated health-system approach for service delivery with the other components including counselling in the general health system (availability).
Counselling by doctors and paramedical staff is especially crucial to track patients and ensuring they complete taking their medication. And one wonders if they have been given their full due. As with COVID-19, they put their lives on the line each time they treat TB patients. They are at the frontline of this battle too, essaying their duty in the diagnosis, delivery of medication, counselling and monitoring of treatment regimes.
Another learning from COVID-19 is that the private and public sectors need to work seamlessly for optimal results. Thus, key health officials now seem to have accepted that the private sector needs to be an intrinsic part of the national TB control mission. As Union health minister Mansukh Mandaviya’s message prefacing the Ministry of Health and Family Welfare’s India TB Report 2022 mentions, ‘From notifications to diagnostics, leveraging the private sector has been an essential component of all strategies to counter the disease.’ The private sector contributed a sizable 31 per cent of the notifications in the year under review.
While Prime Minister Modi’s ambitious End TB deadline is less than three years away, one has no choice but to be an optimist and hope that these and other learnings from the pandemic will help us achieve this difficult, but not impossible goal.