Threat of TB
India continues to have the world’s highest number of TB cases with underdiagnosis eclipsing progress of disease resistance.
Globally, there were 10.4 million tuberculosis (TB) cases in 2016. Southeast Asia, alone, accounted for nearly half of the world's TB burden, reporting an estimated 4.74 million cases with deaths of about 784,000 people.
According to the World Health Organisation's global TB report, titled, 'Bending the curve: ending TB', the disease is the "single largest killer in the 15 to 49 year age group", striking people in their most productive years.
"Since 1990, TB has remained the topmost reason for work days lost. Fighting TB is like fighting poverty. Evidence suggests that for every dollar invested in TB, the return is US$ 43. It makes great economic sense to end this malady," says Poonam Khetrapal Singh, Regional Director of WHO, Southeast Asia.
India continues to have the highest number of TB cases in the world, revealed the TB report released on October 30. India, along with six other countries—Indonesia, China, The Philippines, Pakistan, Nigeria, and South Africa—accounted for 64 per cent of the total burden.
While 45 per cent of new TB cases occurred in Asia, 25 per cent of the new cases were reported in Africa. In 2016, out of an estimated 2.8 million TB patients in India, 423,000 patients are estimated to have succumbed to the illness. Moreover, out of 2.8 million patients, only 1,938,158 cases were notified in the public and private sector in India, leading to 850,000 cases missing out on the treatment options.
Multidrug-resistant TB (MDR-TB) remains a crisis. Globally, according to the WHO estimates, there were 600,000 new TB cases with resistance to rifampicin, the most effective first-line drug. Out of 600,000 new cases, 490,000 had MDR-TB. Almost half of these cases were reported in India, China, and Russia
The emergence of drug-resistant TB has opened up another challenge: curing it with traditional therapeutics. Only 52 per cent of MDR-TB patients around the world were successfully treated. That figure dropped to 49 per cent in Southeast Asia.
Globally, an estimated 250,000 people died of drug-resistant tuberculosis (DR-TB), in 2016. The number of MDR-TB cases detected worldwide represented only 37 per cent of the estimated 340,000 MDR/RR-TB cases among pulmonary TB patients.
Despite high TB burden, the supply chain function has long been neglected. According to The Union, a voluntary scientific organisation, the supply chain for second-line drugs (SLDs) for DR-TB "is fraught with other problems that make it even more difficult to ensure patients are able to receive treatment, let alone to scale up access to diagnosis and treatment for all those who need it".
In India, a new anti-TB drug, bedaquiline, was introduced in 2016, under the Conditional Access Programme (CAP) to improve the outcome of the drug-resistant TB treatment. Between 2000 and 2014, there have been significant improvements in the diagnosis and treatment of TB, saving 43 million lives worldwide. But this piece of good news is eclipsed by the fact that "of the estimated 10.4 million new cases, only 6.3 million were detected and officially notified in 2016, leaving a gap of 4.1 million".
Underreporting and underdiagnosis of TB cases continue to be a challenge, especially in countries with unregulated private sectors and weak health systems. The WHO report claimed that India, Indonesia, and Nigeria accounted for almost 50 per cent of this global gap.
A lack of data collection capacity, which leads to the neglect of TB monitoring and underreporting, remains a hurdle in accurately measuring the TB burden in Southeast Asia, which has a target of reducing TB deaths by 90 per cent and incidence rates by 80 per cent, by 2030, compared to 2015.
In Thailand, for example, which reported 117,000 new cases and 12,000 deaths in 2016, underdiagnosis and underreporting led to the notification gap of at least 50,000 cases. Although there are no precise estimates on childhood TB in Bangladesh, it is assumed that childhood TB is underdiagnosed and drug-resistant TB is growing.
Excess dependence on donors
Globally, investments in TB prevention and care in low and middle-income countries fell almost $2.3 billion short of the $9.2 billion needed. Moreover, at least an additional $1.2 billion per year is needed to accelerate the development of new diagnostics, medicines and vaccines, says the report.
"Shortfalls in TB funding are one of the main reasons why progress is not fast enough to be on track to reach the end TB targets," Katherine Floyd, coordinator of WHO's Monitoring and Evaluation Unit at the Global TB Programme, said.
"Over-reliance on donors and insufficient resource mobilisation even in countries with small funding gaps" is an issue the report highlighted.
(The views expressed are strictly of Down to Earth.)