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World TB Day 2021: Progress undone?

World Tuberculosis (TB) Day 2021 is observed today and while the Indian Government remains optimistic, COVID-19 has presented huge challenges that could see years of work undone.

tuberculosis, TB, COPD Image ID : 83587190 Copyright : Puwadol JaturawutthichaiUnion Minister for Health and Family Welfare Dr Harsh Vardhan delivered an address at the India TB Summit via video conference call highlighting the importance of India’s continued fight against TB

“Under the guidance of our Hon’ble Prime Minister, Shri Narendra Modi Ji, we have accorded high priority to eradicating tuberculosis in India by 2025, five years ahead of the Sustainable Development Goals (SDG) target of 2030. The Government of India is committed to scale up access to free diagnosis through rapid molecular tests also providing information on drug resistance, free treatment for all people with TB, with best-quality drugs and regimens, financial and nutritional support to patients, use of digital technologies for notification and adherence and linking with interface non-governmental agencies to strengthen private sector engagement.”

At the peak of the COVID-19 pandemic in which India reached a height of around 100,000 cases per day, the sentiment from the Government was the same: TB would be eliminated by 2025. Health Issues India has covered the matter in depth on many occasions, noting that experts have debated the feasibility of such a deadline for some years

“The feasibility of realising TB elimination in this timeframe has been debated by experts. It certainly does not appear feasible unless significant improvements are made to existing infrastructure. India lags far behind on targets aimed at reducing TB incidence by ninety percent and TB mortality by 95 percent by 2035 as compared to 2015 as the Lancet Commission on Tuberculosis noted in a report issued [in 2019]. These targets are expected to be met by 2124, almost a century after the fact, should the current trajectory of progress continue to be followed. Such a finding throws cold water on the current prospects of TB elimination by 2025.”

Fears are abundant that the COVID-19 pandemic will have caused significant harm to the global campaigns against numerous diseases. In many countries, the imposition of lockdown measures saw immunisation campaigns halted entirely. Though the lapse was momentary, even the smallest period of time in which infections can run rampant can reverse years of progress.

Such fears were compounded by a report released last week that indicated diagnosis and treatment rates of TB fell sharply during the COVID-19 pandemic. The report showed that nine of the countries with the most TB cases — a total of sixty percent of the overall TB burden globally — saw a decline in diagnosis and treatment of TB infections in 2020, ranging from sixteen percent to 41 percent (averaging 23 percent).

The global reduction in treatment has caused treatment levels to fall back to that last seen in 2008, representing twelve years of lost progress. India was initially one of the worst-affected, though the report notes a rapid analysis of the setback has meant India has quickly taken measures to remedy the issue. India, according to the report, was one of the first countries where the dramatic decline in TB notifications (a total of a seventy percent decline between weeks ten and fifteen of 2020) was noticed and announced. 

Fortunately in the area of TB, India has been able to remedy the situation, with the report stating that by December of 2020 TB notification rates had been alleviated to a similar level as in December 2019. Many diseases have not shared this level of focus, with a common theme throughout the pandemic being the inability to avail standard healthcare services, giving the impression of all other diseases simply being sidelined to combat the pandemic.

Overall, the World Health Organization (WHO) estimated that 1.4 million fewer people received care for TB in 2020 than in 2019, according to preliminary data compiled from over 80 countries. This translated to a reduction of 21 percent from 2019.

While India may be getting back on track, any missed cases offer a breeding ground for the spread of TB. Without diagnosis and treatment the disease is given the chance to run rampant. Given the ongoing fears of the development of drug-resistant strains of TB, any delay in combating the crisis can give rise to an ever more dire situation down the line. As strains are becoming extensively drug-resistant, we grow ever closer to a situation in which TB is all but untreatable.

World TB Day serves as a reminder that while the COVID-19 pandemic is a priority, it is not the only danger we face. This must be made abundantly clear going forward to ensure resources are allocated to other issues, and not solely focused on COVID-19 at the expense of other health concerns.

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