“The TB epidemic is larger than previously estimated” and India is to blame.
This is an alarming statement; perhaps the most alarming statement to be found in the World Health Organization’s (WHO) recently published 2016 Global Tuberculosis Report. However, it is followed by, “the number of TB deaths and the TB incidence rate continue to fall globally.”
The WHO has had to reassess its estimates of the global tuberculosis epidemic, and adjust accordingly because of new surveillance and survey data from India.
The WHO has increased its estimate of new patients with TB in India from 2.2 million in 2014, to 2.8 million in 2015 – with global estimates of new patients shooting up in turn, from 9.6 million to 10.4 million (though this was also, in part, due to revised data from countries such as Indonesia.) The WHO revised total follows a publication in The Lancet, which offered revised estimates for tuberculosis cases in India by incorporating data from the private sector.
A recent study study found that 43 percent of India’s healthare workers suffer from latent tuberculosis (a lower infection rate than China and South Africa, albeit higher than Brazil). The study described this as having “a significant impact on disease transmission as well as healthcare delivery.”
Global deaths from TB in 2015 were estimated at 1.4 million, as well as 0.4 million deaths arising from tuberculosis in HIV-positive peoples.
The report includes India in a list of six countries – the others being China, Indonesia, Nigeria, Pakistan, and South Africa – which account for almost two thirds of new incidences of TB, and warns that “global progress depends on major advances in TB prevention and care in these countries.”
The report said that there needed to be a 4-5% annual decline in cases by 2020 if the first milestone of the End TB strategy was to be met. There was just a 1.5% decrease between 2014 and 2015. This strategy has been undertaken in keeping with the sustainable development goals (SDGs) adopted last year. It calls to reduce TB infections by 80% and deaths from TB by 90% by 2030.
A theme which seems to persist in the report is the notion of a deficit between some progress that has been made and progress which needs to be made, if the goals are to be met.
For example, there is still “a 4.3 million gap between incident and notified cases” – even though 6.1 million new cases were reported to the authorities and the WHO. This was attributed to a “34% increase in notifications in India” – yet India, with Indonesia and Nigeria, still accounts for nearly half of the information gap.
Fewer than a quarter of the 580,000 people with MDR-TB are being treated, the report also says. Again, India accounts for a huge swath of this gulf (along with China, Indonesia, Nigeria, and Russia.)
Spending is lower than it should be, the report notes. Expenditures on combating tuberculosis – in prevention, treatment, research, and development – is short by almost 25% of the necessary US$8.3 billion.
Overall health spending is, the report observes, worse still. Almost every country with a big TB problem falls short of the recommended 6 percent of gross domestic product .
India is near the bottom of the list as Health Issues India has reported before. India’s spending on healthcare equates to less than 2% of its GDP. The report noted in addition that India is the sole member of the BRICS countries whose TB funding its not accounted for either exclusively or predominantly by domestic spending, but rather by international donors.
As a case in point, The New York Times reported last year that an Indian woman was to be treated pro bono at the National Institute of Health in Bethseda, Maryland, after being diagnosed at a hospital in Illinois with extensively drug resistant tuberculosis (XDR-TB), an extremely rare form of Vank’s disease.
Feted pulmonologist Zarir F. Udwadia, who has run a weekly free clinic for the treatment of TB at the P. D. Hinduja Hospital in Mumbai for more than twenty years, openly and controversially lambasted the Indian government earlier this year for their ostensible inaction, commenting that:
“with the new TB drugs approved by the FDA, nobody should be dying of TB. They’re not available here because of government inertia, and that’s unconscionable.”
It was reported by the New York Times at the beginning of September that, since Udwadia’s initial criticisms, the Indian government has “announced increased funding for the country’s TB programs, with a special focus on drug resistance.”
If some steps are being taken towards progress, they are inadequate given the significant strides that need to be made according to the WHO.
Poonam Khetrapal Singh, the WHO’s Regional Director for the South East Asian Region which includes India, was quoted by the Economic Times
“TB is the single largest cause of death of any infectious disease in
the region, and remains responsible for incalculable suffering,
premature mortality, impoverishment and foregone development.
A newer and bolder approach is needed to bend the curve faster and
sharper to achieve the global targets. This means intensifying
measures to ensure early diagnosis and treatment, such as active
case-finding and enhancing access to cutting-edge diagnostic tools.
Adopting newer approaches of case diagnosis, community based
treatment and treatment of latent infection. It means integrating TB
programmes with existing health systems, thereby amplifying the
effect these interventions have.”