Union Health Minister Dr Harsh Vardhan has touted India’s progress in reducing deaths due to tuberculosis (TB), with a nineteen percent reduction in TB mortality since the beginning of the decade.
Affirming the Government’s commitment to eradicating TB by 2025 – five years ahead of global targets to reduce TB incidence by eighty percent and TB mortality by ninety percent – Vardhan informed the Lok Sabha that TB mortality had fallen, from 557,000 deaths in 2010 to 449,000 in 2018. Noting that the number of notified TB cases in India had increased, Vardhan said “as per the latest Global TB report, the estimated number of new TB cases was 26.9 lakh. The total number of notified TB patients has increased by eighteen percent from 1,827,959 in 2010 to 2,155,894 in 2018.”
A significant reduction in HIV-TB mortality was noted by Vardhan. Such deaths declined by 85 percent between 2010 and 2018 per his written reply to Lok Sabha MPs. Deaths in the former year stood at 63,000, compared to 9,700 deaths in the latter. HIV and TB is a relatively common comorbidity, with TB being the leading cause of morbidity and mortality among those living with HIV – accounting for almost 25 percent of such deaths. India’s HIV-TB coinfection rate is an estimated 3.4 percent, with almost 50,000 of the country’s reported cases being a coinfection of the two infectious conditions.
While the progress is impressive, it remains worth noting that TB is a major public health challenge in India, even as the country reports fewer cases and – as Vardhan reports – fewer deaths. At the global level, the world is not on course to realise its targets for reduction of TB cases. The latest World Health Organization (WHO) report on TB – released in October – found that 1.5 million worldwide died from TB in 2018, compared to 1.6 million deaths the preceding year, but that the world failed to meet a target for reducing TB cases by twenty percent between 2015 and 2018.
“The global decline in the total number of TB deaths between 2015 and 2018 was eleven percent, less than one-third of the way towards the End TB Strategy milestone of 35 percent decrease by 2020,” noted the WHO report. While India has made progress, it still has much progress to make. On case notification, where India has effected positive changes, India is responsible for 25 percent of the world’s unnotified cases. Seven million cases were notified at the global level against an estimated ten million cases in actuality. In addition, while treatment success rate has improved, India’s TB treatment rate is just 74 percent.
India also witnesses a substantial burden of drug-resistant TB, in 2018 reporting 58,347 laboratory-confirmed cases of multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB) and 3,400 cases of extensively-drug-resistant TB (XDR-TB). Ridding India of TB by 2025 is challenged by this grim reality, exacerbated by the fact that India – together with China – accounts for 43 percent of the global treatment gap when it comes to drug-resistant forms of TB.
It is worth noting the progress India has made in reducing TB cases and TB mortality. Nonetheless, more needs to be done with existing interventions needing to be capitalised upon to sustain progress and continued vigilance and commitment by authorities.
“Everything has paid off, be it active case finding, engaging the private sector, community engagement,” said a senior official in the Union Health Ministry. “The TB initiatives are being monitored at every level. We are putting targeted interventions in place.”