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Coronavirus to disrupt TB medicine supply?

World TB [Tuberculosis] Day was observed on March 14. A number of points were raised regarding progress against the disease. However, in the era of the coronavirus (COVID-19) pandemic, fears were also raised over supply chains – including by the World Health Organization (WHO). 

TB Photo credit: Prof Madhukar Pai, MD, PhD Canada Research Chair in Epidemiology & Global Health Director, McGill Global Health Programs Associate Director, McGill International TB Centre
X-rays of a tuberculosis patient in India

Officials of the WHO noted that, due to the pandemic and its disruption to airlines, there is the potential that medications for diseases such as TB could be limited in supply. Such an eventuality in the context of TB, particularly owing to the ever-present threat of drug resistance, could lead to a resurgence of the disease. This would, in turn, make other diseases far more difficult to address should the issue of COVID-19 subside in the near future.

The Union Government in India has sought to assuage such fears, asserting that it has enough drugs to treat TB to last until March 2021 and that India’s TB patients will not be affected. However, given the upward trajectory of coronavirus cases the world over at the current time, a stockpile covering the next year may simply not suffice.

Globally, the case count has risen swiftly in recent weeks. Numbering at 789,251 at the time of writing. 38,092 people have died due to COVID-19 while 166,675 have recovered from the virus, leaving 584,484 active cases across the globe. Just over a week previously, Health Issues India reported that global cases had exceeded 200,000 — illustrating the rapid pace of the uptick in infection rates worldwide.

The rate of increase of COVID-19 shows no signs of abating at present. Many of the world’s most developed economies are struggling with the influx of confirmed infections and imposing stringent measures to curb transmission carrying significant socioeconomic impacts. India’s cases are at the start of the same upward trajectory seen in many other nations. Given the relative population size of India, if the outbreak is not handled swiftly, it could soon have the highest number of cases of any country. India has already imposed a lockdown of more than 1.3 billion people to combat the pandemic.

Claims that the Government will ensure drug availability for those affected by TB and drug-resistant strains are already coming under fire. Before the COVID-19 crisis, India had already witnessed stockouts in the private sector of Clofazamine — an essential drug for drug-resistant TB — according to Chapal Mehra, convenor of Survivors against TB, a patient advocacy group, cited in IndiaSpend. “With the COVID-19 crisis, TB services and supply chains are bound to get affected…all this underscores the need to invest in public health, human resources and procurement mechanisms [independent of the Government].”

Given stockpiles have failed in the past, it is not implausible that a similar situation will surface and even be worse considering the present circumstances. Indeed the rest of the country’s infrastructure, be incapacitated by the COVID-19 pandemic and its fallout – as Health Issues India has observed before.

Globally, of the 500,000+ people who develop drug-resistant tuberculosis (DR-TB) each year, India contributes to over 25 percent of cases. This is a critical sticking point in India’s fight against the disease, as a failure to tackle these drug-resistant strains could allow the proliferation of TB cases that are far more difficult to treat. Owing to this any delay due to stockpile issues could have a knock-on effect that presents TB as an even bigger issue further down the line.

The WHO has recently released guidelines to help in tackling TB. They recommend as one of the key principles of the guide to “scale-up of TB preventive treatment among populations at highest risk including household contacts of TB patients, people living with HIV and other people at risk with lowered immunity or living in crowded settings.”

Progress has indeed been made in India. The country has reduced both case count and the number of deaths occurring due to TB. However, progress has been relatively slow — particularly given the current goal of elimination by 2025. Should stockpile issues become a major concern in the near future, this progress towards elimination could quite feasibly be undone. Precautions must be taken in advance to ensure this is not the case. 

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