- Prelims: Current events of national importance(AMR,TB, National TB Elimination Programme, Covid-19, Mission COVID Suraksha etc
- Mains GS Paper II: Government policies and interventions for development in various sectors and issues arising out of their design and implementations etc
ARTICLE HIGHLIGHTS
- The WHO’s Global TB Report 2023, highlighted that since 2015, TB incidence and mortality have declined by 16 per cent and 18 per cent respectively, faster than the decline globally.
- At the One World TB Summit in Varanasi, Uttar Pradesh Prime Minister instilled fresh energy to the global tuberculosis (TB) elimination response and reiterated India’s commitment to spearhead this effort.
INSIGHTS ON THE ISSUE
Context
Tuberculosis:
- TB is caused by a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family consisting of about 200 members.
- Some of Mycobacteria cause diseases like TB and Leprosy in humans and others infect a wide range of animals.
- In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).
- TB is a treatable and curable disease.
- TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
- Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
Areas that need urgent realignment(as per report):
- Reports on drug shortages across some states
- The need to sharpen TB detection exercises
- Importance of nutrition in preventing TB and reducing deaths, highlight policy challenges
- Over 77 percent of presumptive TB patients(2022) were tested through smear microscopy
- It has an accuracy of 22-43 percent and cannot detect resistance to anti-TB drugs.
- By this way we are bound to miss patients and the target.
- Testing needs to pivot to molecular diagnostics urgently.
The WHO report:
- In 2022: A record 2(twenty four point two)lakh TB patients were notified in India.
- The government’s Ni-kshay portal reports: India has already notified nearly 21 lakh cases.
Steps taken for success in TB reduction:
- Universal nutritional support for patients
- Effective engagement with the private sector
- First-of-its-kind crowd sourcing programme to help patients complete treatment.
- Enhanced government funding — from Rs 710 crore in 2014-15 to Rs 3,410 crore in 2021-22.
What steps need to be taken?
- To ensure elimination, we need to augment not just our curative but also detection capabilities.
- A Nature article:“If we cannot find TB, we cannot treat TB”.
- While the programme has been steadfast in scaling up the more advanced molecular diagnostics, uptake has been limited.
- Current testing rate of 1.2(one point two) percent is not enough; we must test at 4-5 per cent.
- Himachal is on its way to 4
- Take example of COVID-19 pandemic: Tapping into the private sector infrastructure and conducting nearly 10 lakh RT-PCR tests every day.
- We must re-look at our policies and make it happen for TB testing as well.
- Reconsider screening tools: Even today, we heavily rely on symptomatic screening which has an inherent challenge.
- As per the ICMR’s national prevalence study: 46 percent of diagnosed cases were asymptomatic and were detected only due to the use of chest x-rays.
- The availability of portable AI-enabled X-Ray applications can be an efficient and affordable alternative.
How can a country out to defeat TB afford drug shortages?
- All the positive cases are initiated on treatment.
- The Centre passing the buck to states at the last minute is not the best approach.
- While decentralization is a constructive move to improve planning and delivery
- It may often put them at a disadvantage in negotiating prices due to local constraints and a lower volume required as compared to the central government.
- We must recognise that ensuring treatment adherence is paramount and without drug shortage.
- This brings us to recognise that better and less toxic treatment options must be considered.
- For example: the WHO-recommended BPaL(M) regimen for drug-resistant patients
- It has shown to have an efficacy of 85-90 percent
- More than 30 percentage points better than the existing regimen — must be made available.
- Recognise that without a vaccine, the impact would be minimal.
- For TB. BCG is used in infants, but experts feel it is not enough.
Initiatives:
Way Forward.
- It is time to reassess our action plan for the TB programme.
- The COVID-19 pandemic proved India’s apt title: pharmacy of the world.
- Our scientific ingenuity during the pandemic has cemented our position as pioneers in innovation in the life sciences.
- We must create a strong platform that channelises investments in research to bring in a paradigm shift at every stage of the TB care cascade — prevention, testing, and treatment.
- TB should no longer be the leading infectious disease killer globally, in the 21st century, and India can lead the way.
QUESTION FOR PRACTICE
Critically examine the role of WHO in providing global health security during the COVID-19 Pandemic.(UPSC 2020) (200 WORDS, 10 MARKS)
