Initiatives India can prioritise to eliminate TB by 2025

TB has claimed more lives in history than any other infectious disease. Even today, India bears the highest global burden, with 27% infections and 55 deaths every hour besides a million undetected cases every year.

Apart from being a critical public health problem, it is also associated with poor socio-economic development, marginalisation and exploitation.

The actions required to tackle the socio-economic structural determinants of TB lie beyond the preview of the health sector alone calling for a harmonised multi-sectoral response.

The National TB Management Framework makes a strong case for elimination efforts from a health sector struggle to coordinate the collective endeavour of the government, the private sector, civil society, corporates and other stakeholders. It emphasises complementarity and capitalizes on potential synergies to accelerate the outcomes.  

India has committed to the United Nations General Assembly to end TB by 2025, five years ahead of the deadline given in the Sustainable Development Goals.

We have done a reasonably good job of formulation of a viable and inclusive policy framework and the National Strategic Plan.

The key objectives of our goals should be to achieve policy convergence with a focus on strategic areas such as integrating TB in health care service delivery, creation of TB free workplace, ensuring socio-economic support to patients, awareness generation and infection control, including screening the vulnerable groups for latent TB, the transformation of societal behaviour to reduce stigma and social discrimination, productive integration of private sector, stepping up of corporate social responsibility and investment in TB besides targeted interventions for key populations.

India has experimented successfully with the public-private partnership model, which is now being replicated in more than 242 districts with the coalition of the government and the civil society (JEET Project).

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Since 70% of our patients still rely on the private sector, it would be path-breaking to streamline the existing public-private arrangement keeping in view the characteristics and needs of different regions.

Even though the concerted effort of the National TB Elimination Programme has to its credit the world's biggest DOTS Therapy by treating nearly 20 million people in 15 years, its outreach is limited because of the enormity of our burden and limitations of our health infrastructure, including health volunteers and workers.  

India has 2,70,000 elected local governments at the grassroot level. Public health is an obligatory function of these highly underutilised institutions. They are closer to people and understand ground realities better.

These can be integrated with governments structures with enhanced skill-building. In collaboration with local communities, peripheral decision-making composite units can be formed under the guidance of Panchayati Raj representatives at block/village levels.

They will enhance accountability, enable prioritisation and improve facilities and delivery of services. We must also build capacities of community-based organisations and health workers like ASHA and ANM, who performed commendably during the COVID crisis despite the meagre honorarium. We need to expand these cadres and strengthen their financial support.  

We cannot overlook the vital role that the local communities and the civil society can play as key partners of our national endeavour. Elected representatives including parliamentarians, legislators and corporators need to be sensitised and taken on board.

Global Coalition Against TB (The policy Makers Forum) has been successfully motivating and mobilising them for advocacy, support, and strengthening monitoring mechanisms besides running information and awareness campaigns.

Because of the commonality of symptoms between TB and COVID, we must continue with the bidirectional screening initiated during the Rapid Response Plan announced by the government to mitigate the burden.  

The recently launched 'Jan Andolan Programme' by the central government must also co-opt every possible source to create a sense of alarm across the country about the need to eradicate the devastating TB epidemic by using services of celebrities including renowned film stars, artists, writers, intellectuals, sportspersons and other vital influencers of society.  

If we have to achieve our dream of TB Free India by 2025, we must continue to strengthen our political resolve, step up research and development, innovate and use tools of information and communication technology, introduce molecular diagnostics at the village level and bring synergy between all stakeholders with multi-sectoral coordination.  

India also has to address on war footing issues like poverty, malnutrition, proximal living spaces, urban planning, hygiene and sanitation and pollution control.

Mumbai has more than 50% population living in slums and has the highest incidence of drug resistance TB globally. The spurt in diabetes and tobacco smoking, which has impacted TB mortality, needs to be handled.  

A century has passed since the BCG vaccine was introduced, which provides moderate protection against TB in infants and children. We must build on successful capacities of the COVID vaccine, scale-up coordinated research with increased political commitment backed by massive investments.

We could find an early breakthrough from amongst the 14 TB vaccines candidates in clinical trials to end one of the deadliest diseases of our times.  

(The author is President, Global Coalition Against TB.)

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