India’s 100-Day TB Elimination Campaign

Syllabus: GS2/Health

Context

• In a decisive step towards eliminating TB in India, the Ministry of Health and Family Welfare, is all set to launch the 100 Day TB elimination campaign.

About

• The initiative, set to be implemented in 33 States and Union Territories, has been designed to enhance TB case detection, reduce diagnostic delays, and improve treatment outcomes. 
• India’s goal is to eliminate tuberculosis (TB) by 2025, five years ahead of the global target of 2030.
• Global TB Cases: TB remains the leading infectious killer, surpassing COVID-19, with 8.2 million new cases in 2023.
• India’s TB Burden: India, with the highest TB burden globally, recorded 2.8 million cases in 2023.
  • India alone accounted for 26% of global cases and 29% of global TB deaths (315,000 deaths).
  • India is followed by Indonesia (10%), China (6.8%), the Philippines (6.8%), and Pakistan (6.3%).
• Multidrug-Resistant TB: India represents 27% of the world’s multi-drug-resistant TB cases, underscoring the need for specialized treatment approaches.

What is Tuberculosis?

• Tuberculosis (TB) is an infectious disease that most often affects the lungs and is caused by the bacteria Mycobacterium tuberculosis.  
• It spreads through the air when infected people cough, sneeze or spit.
• Symptoms: prolonged cough (sometimes with blood), chest pain, weakness, fatigue, weight loss, fever, night sweats.
  • While TB usually affects the lungs, it also affects the kidneys, brain, spine and skin.
• Treatment: It is preventable and curable with antibiotics.
  • TB Vaccine: The Bacillus Calmette-Guérin (BCG) vaccine remains the only licensed vaccine against TB; it provides moderate protection against severe forms of TB (TB meningitis) in infants and young children.

Challenges Faced by India in Eliminating TB

• Drug-resistant TB cases: India has a significant burden of drug-resistant TB, including multidrug-resistant TB (MDR-TB).
  • This type of TB is much harder to treat and requires more expensive, specialised drugs and a longer duration of treatment.
• Diagnostics and Case Detection: The accurate and timely diagnosis of TB remains a challenge.
  • Some areas lack access to modern diagnostic tools, leading to reliance on older methods with limitations. 
• Poor primary health-care and infrastructure: In many parts of India, especially in rural and remote areas, there is limited access to healthcare facilities.
  • This can result in delayed diagnosis and treatment, allowing TB to spread within communities.
• Stigma and Awareness: Stigma associated with TB lead to delays in seeking healthcare, and lack of awareness about the disease may contribute to its persistence. 
• Private Sector Engagement: A significant portion of healthcare services in India is provided by the private sector.
  • Coordinating efforts between the public and private sectors and ensuring standardized treatment protocols are crucial for effective TB control.
• Treatment Adherence: TB treatment requires a prolonged course of antibiotics, and ensuring patient adherence to the full course is challenging. 
• Vulnerable Populations: Certain populations, such as migrant workers, urban slum dwellers, and those living in crowded conditions, are at higher risk of TB.

Steps Taken by Government of India to Eliminate TB

• Revised National Tuberculosis Control Program (RNTCP): The RNTCP, launched in 1997, was the flagship program to control TB in India.
  • The program has been continuously revised and strengthened over the years.
• National Tuberculosis Elimination Program (NTEP): The Government of India has developed a National Strategic Plan (2017-25) for Ending TB in the country by 2025.
• Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA): Launched in 2022 for community support to TB patients with the objective to provide people with TB with additional nutritional, diagnostic and vocational support.
• Universal Drug Susceptibility Testing (DST): The government has scaled up efforts to provide universal access to drug susceptibility testing, helping to identify drug-resistant strains of TB early and tailor treatment accordingly.
  • Earlier, the patients were started on first line treatment and were tested for drug resistance only if the therapy did not work. 
• Ni-kshay portal: An online Ni-kshay portal has been set up to track the notified TB cases.
• New Drugs: Newer drugs such as Bedaquiline and Delamanid for the treatment of drug-resistant TB have been included in the government’s basket of drugs provided free TB patients. 
• R&D for Treatment: Researchers have been studying shorter three- and four-month courses of anti-tubercular drugs, instead of the existing six-month therapy.
• Vaccine Development: Trials are underway to test the effectiveness of a vaccine called Immuvac, which was initially developed to prevent leprosy, in preventing TB.
  • Researchers are also testing VPM1002, which is a recombinant form of the BCG vaccine modified to express the TB antigens better. 

Suggestions

• Setting norms and standards on TB prevention and care and promoting and facilitating their implementation.
• Developing and promoting evidence-based policy options for TB prevention and care.
• Monitoring and reporting on the status of the TB epidemic and progress in financing and implementation of the response at global, regional and country levels.

Source: PIB