Despite some progress, a new global report on tuberculosis has warned, India is faltering in treating patients, especially those with drug-resistant versions of the disease and under-funding its eradication efforts.
The result is that India-with 17.7% of the planet’s population and 27% of its TB patients, more than any other country-is unlikely to meet its target of eliminating tuberculosis by 2025.
There has been a 1.7% reduction in tuberculosis cases–short of the 10% required to meet the 2025 TB-elimination target–and 3% reduction in deaths in 2017 compared to the previous year, noted the Global Tuberculosis Report 2018 by the World Health Organization (WHO) released on September 18, 2018.
India’s TB cases have declined from 2.79 million in 2016 to 2.74 million in 2017, a reduction of 1.7%–a little slower than the 2% annual reduction across the world, which now has 10 million cases. TB deaths have dropped from 423,000 in 2016 to 410,000 in 2017.
There was also a reduction in rifampicin–first-line TB drug–resistant tuberculosis (RR TB) and multidrug-resistant tuberculosis (MDR-TB) from 147,000 cases to 130,000 cases in 2017, a reduction of 8%.
RR TB and MDR-TB cases are difficult and more expensive to treat with a 46% success rate. India has 24% of the world’s drug-resistant TB burden.
Further, India is still a long way from its TB elimination goal and has challenges in getting patients on treatment, treating drug-resistant TB patients and meeting funding requirements.
Elimination far ahead
The decline in TB cases and deaths, as we said, is not enough to meet the elimination target.
India had announced a plan to eliminate TB by 2025, five years before the global target of 2030.
Since 2016, India’s TB incidence dropped 1.7% annually, compared to a 4-8% decline in Southern African countries, such as Eswatini (formerly Swaziland), Lesotho, Namibia, South Africa, Zambia and Zimbabwe.
India needs a 10% annual drop in TB cases to eliminate the disease by 2025, Soumya Swaminathan, former director general of Indian Council of Medical Research and now a deputy director general at WHO, told IndiaSpend in November 2017.
“Eliminating” TB would mean less than 10 cases per 100,000 population per year. In 2017, India’s TB incidence was 204 per 100,000 population.
To achieve its goal of eliminating the TB epidemic in 10 years, by 2025, India would have to reduce new TB cases by 95% over the next decade, FactChecker reported in March 2017.
Currently no more than 65% of TB patients in India are treated, which means more than a quarter of the burden may not be adequately addressed and may even transmit the disease further, according to the report.
Better notification but still a long way to go
Globally, 32% cases were not notified–the process of reporting the disease to the government surveillance system–with India accounting for 26% of what is in officialese called the “notification gap”, the highest in the world.
Underreporting of cases, under-diagnosis–people do not go to a doctor or they do not get diagnosed when they do–and overestimation of new cases could be the reasons for the gap between estimating and reported cases, said the report.>