India’s Winding Road To ‘EndTB’

Syllabus: GS2/Health

Context

• India’s journey towards eliminating tuberculosis (TB) by 2025, under the ambitious ‘EndTB’ campaign, has been fraught with challenges and complexities. 
• Despite significant strides, the road to achieving the targets set by the World Health Organization (WHO) remains steep and winding.

About the Tuberculosis (TB)

• It 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.
• It is the world’s leading infectious disease killer. It is the leading cause of deaths among people with HIV and a major contributor to deaths associated with antimicrobial resistance.
• 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.

Burden of TB in India

• According to the WHO’s Global Tuberculosis Report 2024, India continues to lead the global TB burden, accounting for 26% of all TB cases and deaths, and remains a hub for drug-resistant TB (DR-TB).
• 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.

‘EndTB’ Strategy of WHO

• It aims for a 90% reduction in TB deaths, an 80% reduction in new cases, and zero TB-affected families facing catastrophic costs by 2030.

• The United Nations SDGs include ending the TB epidemic by 2030 under Goal 3.
  • SDG Target 3.3: It aims to ‘End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases, and other communicable diseases by 2030’.

India’s Specific Targets and Performance

• India pledged to achieve these targets on an accelerated timeline by 2025, but the COVID-19 pandemic significantly hampered these efforts.
• There has been a decline of only 18% in TB cases between 2015 and 2023 as against the target of 50% by 2025.
  • TB deaths have declined by 24% as against a target of 75% by 2025.

Towards a TB-Free India

• National Tuberculosis Elimination Programme (NTEP): It has been at the forefront of an ambitious goal to achieve WHO Targets by the end of 2025, but the COVID-19 pandemic significantly hampered these efforts.
  • It has been implementing the National Strategic Plan (NSP) for TB Elimination (2017–2025).
• Key Achievements of NTEP:
  • Decline in TB Incidence: India has achieved a noteworthy 17.7% decline in TB incidence from 2015 to 2023, surpassing the global average decline of 8.3%.
  • Expanded Diagnostic Reach: In 2023, India conducted approximately 1.89 crore sputum smear tests and 68.3 lakh nucleic acid amplification tests, reflecting the programme’s commitment to expanding access to early diagnosis.
  • Shorter Treatment Regimens: The introduction of new, shorter regimens for drug-resistant TB (DR-TB) has improved treatment adherence and reduced the burden of prolonged therapy.
• Revised National Tuberculosis Control Program (RNTCP)
• Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA): To provide people with TB with additional nutritional, diagnostic and vocational support.
• Ni-kshay Portal: It has been set up to track the notified TB cases.
  • Direct Benefit Transfer (DBT) under the Ni-kshay Poshan Yojana provides financial support for TB patients by disbursing nearly Rs. 2,781 crores to around 1 crore beneficiaries.
  • Notably, over 1.5 lakh Ni-kshay Mitras have committed to supporting individuals affected by TB.
  • Ni-kshay SAATHI (Family caregiver model) to further enhance patient support systems.
• Universal Drug Susceptibility Testing (DST): To identify drug-resistant strains of TB early and tailor treatment accordingly.
• New Drugs: Bedaquiline and Delamanid for the treatment of drug-resistant TB have been included in the government’s basket of drugs provided free TB patients.

Challenges on the Ground

• Undernutrition and Comorbidities: High-risk groups, such as individuals exposed to factors like silicosis, undernutrition, overcrowding, and comorbidities like diabetes, alcohol use disorders and smoking are particularly vulnerable to TB.
• Migrant Workers: They face additional challenges due to poor access to healthcare and difficulty continuing treatment when moving back to their native places.
• Supply Chain Disruptions: A country-wide break in the supply chain in 2023 led to shortages of key drugs, disrupting treatment and risking antibiotic resistance.
• Diagnostic Delays: Despite efforts to expand diagnostic capabilities, delays in diagnosis remain a significant challenge.
  • While the NTEP’s main focus has been on pulmonary TB, Extrapulmonary TB (EP-TB), which affects organs other than the lungs, accounts for about 24% of notified cases.
  • EP-TB is often missed or diagnosed late due to vague symptoms resembling other diseases.

Way Forward

• Multisectoral Approach: Tackling TB requires a multisectoral approach, addressing not only undernutrition but also other contributory factors in each geography.
• Community Engagement: Successful interventions have shown the importance of community participation and advocacy in achieving TB targets.
  • Successful interventions, such as the collaboration with Kudumbashree, a women’s self-help network in Kerala, have shown the importance of community participation and advocacy in achieving TB targets.
• Continued Political Commitment: The strong political commitment shown by the Government of India, including the reaffirmation of the ‘End TB by 2025’ goal, is crucial for sustained progress.

Conclusion

• India’s journey to ‘EndTB’ is a testament to the country’s commitment to tackling one of the world’s most pressing health challenges. 
• While the path is fraught with obstacles, continued efforts, multisectoral action, and community engagement are crucial to achieving the ambitious targets set by the WHO.

Source: TH