India holds a disproportionate percentage of the world’s new cases, and deaths associated with tuberculosis (TB). In 2015 India accounted for 2.8 million cases of the world’s total 8 million, with a similar percentage of deaths associated with the disease — 480,000 of a total of roughly 2 million. Despite attempts in the past few years by the Indian government to provide treatment and undertake preventative measures, TB is actually increasing in prevalence.
TB is caused by the bacteria, Mycobacterium tuberculosis complex. Disease pathology primarily occurs in the lungs, though the infection can be present within the bones, glands and nervous system. Symptoms manifest as a persistent cough, usually lasting over 3 weeks, fever, loss of appetite and fatigue. It is the persistent cough which allows the disease to be so communicable as it is passed on to others via droplets released when coughing, sneezing and speaking.
The disease has the potential to be deadly. However, it is treatable with a course of antibiotics, preventative measures are also available such as the BCG vaccine. This vaccine, while disappointingly shown not to reduce infection rates has been documented in some studies to have some value in symptom management, in particular the haematogenous complications of primary infection. These positive implications of the vaccine however are non-existent if coupled with malnourishment, a common issue amongst those in poverty.
India in recent years has seen a rise in antibiotic resistant TB. This has not altered despite the Indian government launching the “TB free India” campaign. Several policies of the campaign have not yet been implemented and India has seen a rise of an antibiotic resistant strain of TB – multidrug-resistant TB (MDR-TB) – with hotbeds in areas such as Mumbai. This has led to pressure from the international medical community as failure to address the spread of this could lead to the infection occurring in more countries.
As Health Issues India has reported before, some issues occur in the treatment of TB in India due to disparities in the information of government provided healthcare and the private sector, World Health Organisation (WHO) data does not account fully for the 1.19 to 5.24 million people receiving private treatment for TB as a Lancet paper this summer explained.
This difference in data used has led estimates for the death toll to rise from 220,000 in 2014 to 480,000 in 2015 after revised estimates by the WHO. This situation is currently being rectified as in 2012 laws were passed making it mandatory for private doctors to share information with the government. However, many remain sceptical about compliance with those laws.
Coupled with better data sharing and the incorporation of more patients into government observed treatment, the Indian Council of Medical Research (ICMR) has also created the India TB Research and Development Corporation (ITRDC). A collaborative and ambitious attempt at reducing the infection and mortality rate in India by 95%, this endeavour has brought together groups such as the Ministry of Health & Family Welfare (MOH&FW), Council of Scientific and Industrial Research (CSIR), WHO, and the Gates Foundation, who agreed support in February 2016. This attempt at the eradication of TB will depend on Government committing sufficient funds.
Progress towards this goal was confirmed and applauded at a meeting in New Delhi of the International Scientific Advisory Group (ISAG) that convened on the 9-10th of November, giving hope that this newfound attempt at TB treatment will have more success in the coming years.