A TB free India is far away

Abstract

TB is a major health issue in many countries including India. In India, the burden of TB is the highest and the number of drug resistant TB (DR-TB) cases is very high. But there is an acute shortage of drugs for treating the DR-TB. The world is not able to eliminate TB due to the infections caused by antimicrobial resistance. The resistance is caused by repeated or continuous use of antibiotics. It is advised by the WHO that there should be limited prescriptions from the ‘Watch” and ‘Reserve’ categories. But in India more than 50% of the antibiotics prescribed are from the ‘Watch’ group. Resistance results in the mutation of single-cell pathogens and the mutated pathogens have evolved their own defence mechanisms to inactivate or evade the drugs. But there is limited/no development of new antibiotics to combat antimicrobial resistance, particularly DR-TB. The total investment made in R&D on antibiotics by major companies is only 17.5% of the total revenue. In India, to eradicate TB the Health Ministry rolled out the National Strategic Plan (NSP) 2017–2025, which aims at increasing the number of individuals who have been undergone precision test from 0.04 million to 13.4 million in 2022. Instead of this target the achieved number is only 4.1 million. And so a new strategic plan 2020 – 2025 was launched; the revised NSP has raised the bar even further. But in India, there are only limited facilities to conduct the precision test and so India is not able to achieve even the diagnostic target. The reasons for this state of affairs are: poor quality/non-availability of drugs, delayed treatment/missing TB cases (there are a few millions of non-notified TB patients in the private sector) and high load of drug resistant pathogens. There are also a number of other vulnerable groups of people who have to be tested immediately with presumptive TB. All these mean that India requires huge resources to combat TB. But in India resources available are very limited. It means that India failed in all aspects and so no one can expect a TB-free India even in 2030 without a comprehensive multifaceted approach.