The Union Health Ministry has recently decided to make failure to report TB cases to the health authorities a criminal offence. Its notification stated that clinical establishments (hospitals and clinics in all recognised systems of medicine), doctors, chemists and druggists should notify every TB case to local public health authority - District Health Officer or Chief Medical Officer - in a prescribed format. It has introduced provisions for jail term if the major stakeholders in the fight against TB fail to report such cases to the nodal officer and if the health staff fail to take appropriate action on getting the information. The notification further says, clinical establishments, including those in the private sector, will face punitive action if they fail to notify TB cases to the local public health authority. Moreover, all pharmacies, chemists and druggists dispensing anti-TB medications must provide details of the patient, prescription and medical practitioner concerned to the nodal officer of the district failing which action will be taken against them. Now, failure to report TB cases will attract the provisions of sections 269 and 270 of the Indian Penal Code. Section 269 refers to a negligent act likely to spread infection of disease dangerous to life and Section 270 to a malignant act likely to spread infection of a dangerous disease. The offenders could face imprisonment up to two years. In India, TB has been a notifiable disease since 2012, but the reporting was not mandatory till recently and pharmacists or chemists were not included.

Unfortunately, there is resistance from some stakeholders in the private sector who slam the rule as too severe and unacceptable. The All India Organisation of Chemists and Druggists, representing around 8.5 lakh chemists in the country, has urged the ministry not to penalise chemists for failing to report TB cases as they are facing difficulty in obtaining residential address, identity proof and mobile/telephone number of TB patients or their relatives. The government's decision also did not go down well amongst the medical practitioners. Indian Medical Association has stated that the new rule may act as deterrent for hospitals and clinical establishments to provide treatment for TB patients. It is possible that the ministry’s new rules may provide a more realistic picture of the prevalence of the disease in the country and help track the ‘missing million’ - unregistered or undetected patients. Given the alarming situation of emergence of multidrug-resistant TB as a public health crisis, the ministry's move seems to be justifiable. According to the Global TB Report 2017 released by WHO, India is on top of the list of nations with maximum number of people afflicted with the dreaded disease. 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. 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. 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. While the world has committed to end this disease by 2030, India has set an ambitious target of eradicating this disease from this country by 2025. Whatever may be the difficulties faced by the chemists, doctors or other stakeholders, they all need to cooperate with the government to achieve this noble health mission.