Over nine lakh people in India are not getting treatment for tuberculosis. Last year, out of the one crore people estimated to be suffering from the disease world over, 36 lakh cases did not receive any treatment, according to the WHO's recently released Global Report on TB.
India is one of the four countries that contribute to about half of this gap between the incidence of the disease, and its detection and notification, the report says.
“The gap is a cause for concern because if left undetected, or untreated, the disease may get complicated or, those suffering may simply die for want of treatment. The longer the disease is left undetected, the higher the chance that the patient will end up transmitting the infection in the community. Besides, if wrongly treated in the private sector [majority of cases in India are being treated in the private sector], it may also give rise to drug resistant TB,” said Leena Meghaney of MSF Access Campaign that works on increasing access to treatment for neglected diseases.
Today, TB is one of the three main killer infectious diseases, along with malaria and HIV/AIDS. Currently, one in every five people with TB dies. In India alone, nearly half a million people die of TB every year. The Centre's target is to eliminate the disease by 2025, five years ahead of the global deadline. For that to happen, however, this crucial gap will have to be breached, and those falling off the treatment map currently would have to be roped in.
According to the report, in 2017, globally, 64 lakh new cases of TB were officially notified to the national authorities and subsequently, reported to the WHO. Since 2013, this number has been rising; annually about 58 lakh cases were reported from 2009 to 2012. The rise in the global numbers is being attributed to the increased reporting of detected cases by the private sector in India and, in 2017, a rise in notifications in Indonesia.
According to the estimates by the report, globally, about five lakh people also developed TB that was resistant to rifampicin (RR-TB)—the most effective firstline drug—in 2017. Of these, 82 per cent had multi-drug-resistant TB (MDR-TB). A quarter of the drug resistant and multi-drug resistant cases (1,33,920) were in India.
Of the five lakh globally, a little over one lakh cases of MDR/RR-TB were detected and notified in 2017. Eighty-seven per cent of these were enrolled on treatment with a second-line regimen, which is a small increase since 2016. However, this is only 25 per cent of the estimated people who developed MDR/RR-TB, says the report.
Unsurprisingly, India and China are major contributors to this figure, too. Together, they accounted for 40 per cent of the global gap between notification and detection, and incidence of drug resistant TB, says the report. Globally, the treatment success rates, too, are low—55 per cent. In countries such as India, China and Indonesia, the treatment success rates were less than 50 per cent. In India, this was due to high rates of death and loss to follow-up (20 per cent, and 19 per cent).
The high burden countries, where better treatment success rates are being achieved, include Bangladesh, Ethiopia, Kazakhstan, Myanmar and Viet Nam—all of which have rates above 70 per cent.
As the Centre and the states race towards the TB elimination deadline for the year 2025, the report also notes a particularly striking increase in the TB-specific budget, and within this, funding from domestic sources. Between 2016 and 2018, domestic funding for the national budget for TB in India more than quadrupled, from USD 110 million in 2016 to USD 458 million in 2018.
India has the highest burden of tuberculosis in the world—each year, 29 lakh new cases of TB are reported; 4.20 lakh people, mostly poor, die of the disease. Economic loss due to TB has been calculated at Rs 20,000 crore per annum.