The World Health Organization has recently released the Global TB Report 2017 which has placed India on top of the list of nations with maximum number of people afflicted with the dreaded disease. In 2016, there were an estimated 10.4 million new TB cases worldwide. Seven countries accounted for 64% of the total burden, with India having the maximum number of TB patients, followed by Indonesia, China, Philippines, Pakistan, Nigeria and South Africa. In India, an estimated 27.9 lakh patients were suffering from TB in 2016 and up to 4.23 lakh patients were estimated to have died during the year. What is alarming is the emergence of multidrug-resistant TB which remains a public health crisis and a health security threat. WHO estimates that worldwide, there were 600,000 new TB cases with resistance to rifampicin - the most effective first-line drug, of which 490,000 had MDR-TB. Almost half of these cases were in India, China and the Russian Federation. The WHO report highlights the fact that under-reporting and under-diagnosis of TB cases continue to be a challenge, especially in countries with large unregulated private sectors and weak health systems, including India. The report finds 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. India, Indonesia and Nigeria accounted for almost half of this global gap. Only one in five MDR-TB cases was started on treatment. India and China accounted for 39% of the global gap.
Meanwhile, India has reaffirmed its commitment to eliminate TB by 2025 and has made several announcements in this direction. At the 'First WHO Global Ministerial Conference on Ending TB in Sustainable Development Era’ held recently in Moscow, India has affirmed that just as it has ended polio, it will use a similar intensified effort to end TB by 2025. It was stated that the Indian government is giving top priority to addressing the quality of care for patients and 25% of the ministry's budget is earmarked for direct interventions in this area. This include free diagnosis with rapid molecular tests, free treatment with best quality drugs and regimens, financial and nutritional support to patients, online TB notification systems, mobile technology based adherence monitoring system, interphase agencies for better private sector engagements, policy for transparent service purchase schemes, stronger community engagements, communication campaigns and regulatory systems to capture information on all those consuming anti-TB drugs etc. More recently, the government has launched a treatment strategy for TB patients from thrice weekly to daily drug regimen using fixed dose combinations under which the daily FDC anti-TB drugs will be made available free of cost to private pharmacy or at private practitioners to dispense to TB patients who seek care in private sector, depending upon the convenience of patient and practitioner. The ministry will take this forward with all major hospitals, IMA, IAP and other professional medical associations to expand the access to daily FDC to all TB patients. Though the government's aggressive posture is laudable, it has to keep in mind that no piecemeal approach will give any fruitful results to eliminate this dreaded disease. A concerted effort by the government and all the stakeholders is the need of the hour.