India's fight against the scourge of TB is a mixed bag. While India has pledged to eradicate the disease by 2025, and has brought 63 lakh TB patients under a WHO-recommended treatment, the cost of treatment offers a major challenge. Here's how India's battle against TB is shaping up
Member-states of the United Nations, including India, observe World Tuberculosis Day on March 24 every year to build awareness about tuberculosis, a disease that claims nearly 1.5 million people each year across the globe, mostly in developing countries, making it one of the top 10 causes of death worldwide.
It is estimated that if the scourge was to be eradicated totally from the face of the earth, it would require an initial investment of $65 billion for a five-year programme, but lead to an ROI of $1.2 trillion for world economy. In fact, one of the health targets of the Sustainable Development Goals is achieving complete eradication by 2030.
In India, TB is the “leading cause of adult illness and death from a communicable disease”, according to the World Bank; the country also accounts for a fifth of the world’s TB burden – the highest among the “high-burden countries” – with some 18 lakh people getting infected every year, and an estimated four lakh dying from it annually.
Global Health Education, a UK charity that seeks to improve health through education, particularly in relation to diseases that have a global impact such as TB, quotes WHO numbers to underscore another alarming trend in India: an estimated 40% of its population is infected with TB bacteria.
What is equally alarming is that the vast majority of this infected population has latent TB, rather than the disease itself. This means that millions of Indians are leading a perfectly normal life without realising they are infected.
And while it is true that those with latent TB infection are not infectious – meaning they do not endanger uninfected people – what is also a fact that without treatment, about 5-10% of the infected persons are bound to develop the disease at some time in their lives. But why will one undergo treatment if the person is unaware of his or her state?
The Good News
India has pledged to eradicate the disease by 2025, and going by all accounts, is doing a good job. Non-profit GHE says treatment success rate among new TB patients has “remained consistently above 85%”, while that from previously treated patients is also at a high 70%.
The World Bank notes that ever since India adopted the Revised National TB Control programme in 1997, more than 63 lakh TB patients have been brought under a WHO- recommended treatment known by its acronym DOTS (Directly Observed Treatment, Short-course).
This has led to over 10 lakh lives being saved. “Even with the rapid expansion of this rigorous approach, sound service delivery has been maintained,” says the World Bank, which has extended financial support of $312 million in two tranches since inception.
India’s DOTS programme is the “world’s fastest-expanding programme”, it says, apart from being the largest in terms of patients initiated on treatment. “It is now available in all districts of India and covers more than one billion people.”
The Bad News
But if there is good news, there is a flip side too: in this case, it is the expenses; it can get prohibitively expensive.
According to an article by an expert in the prestigious medical journal BMJ (previously the British Medical Journal), the cost of branded drugs required for a full course of treatment for multi-drug resistant TB can go up to as much as $3,500 (about Rs 2.43 lakh, as per March 15, 2019 conversion rates).
Add to these hospital costs, pre- and post-treatment costs and sundry other related expenses, not to mention the inability to work during this period, the overall financial strain gets exorbitant. Moreover, health covers may not prove adequate for several reasons, though they are definitely recommended to ease the burden somewhat.
Rise of Private Sector
Ironically, despite the growing success rate of the DOTS programme, and the fact that the Indian government provides free diagnosis and treatment at its health centres, an overwhelming majority of affected people choose to spend money for treatment at private clinics, primarily because they are more accessible.
The journal The Lancet, globally reputed for its scholarly studies on medicine, undertook a survey of TB treatment in India in 2013-14 and found that “overall, on a national level in both years, there was roughly twice as much tuberculosis treatment in the private sector as in the public sector.”
In terms of hard numbers, Lancet said 2·2 million “genuine cases” were treated in the private sector in 2014, compared with 1·42 million in the public sector. This trend was also witnessed in the sale of drugs, both branded (sold only in the private sector) and "non-proprietary” drugs (sold at public sector clinics).
A huge number of TB patients rarely get tested for drug resistance. As a result, numerous cases of drug resistant -TB do not get diagnosed and are “lost” or in WHO parlance, “missing”. Often, treatment of such cases is below-par, mainly because of a wrong diagnosis.
Two other factors have been identified for the spread of TB in India, apart from poverty, malnutrition and unsanitary living conditions: the rampant use of tobacco and the prevalence of diabetes. According to one estimate, smokers accounted for 66% of males who died from TB in the country.
Although TB afflicts all age groups, most victims are adults in peak productive years – in the 15-59 years age bracket. And as the disease it occurs mostly among the poorer sections, it can push individuals, families and communities into poverty, suffering and debt.
For the middle-class, loss of earning capability of the primary breadwinner can also prove financially debilitating for the family. Thus, it becomes important to insure your health. Read more.