Date: 24/03/2023

Relevance: GS-2: Issues Relating to Development and Management of Social Sector/Services relating to Health; Government Policies and Interventions for Development in various sectors and Issues arising out of their Design and Implementation.

Key Phrases: World Health Organization, Tuberculosis, socio-economic price, Ending TB in India, gender-responsive approach to TB, Nikshay Poshan Yojana, World Development Report.

Context:

• The World Health Organization declared tuberculosis (TB) a global health emergency in 1993.
  • The 1993 World Development Report labeled TB treatment for adults as the best buy among all developmental interventions.
• The response in the 30 years since has been short on urgency and long on processes.

Key Highlights:

• The current goal is to end TB by 2030, but clarity on definitions of ‘end’ and the means of verification are not fully in place.

About Tuberculosis (TB):

• TB is caused by a bacterium called Mycobacterium tuberculosis.
• It affects the lungs (pulmonary TB), can affect other organs (extra-pulmonary TB).
• It is a contagious, treatable and curable disease; BCG vaccines are used to prevent.
• Drug Resistant-TB (DR-TB) is a form of TB which is not treatable by routinely used TB drugs.
  • MultiDrug Resistant Tuberculosis (MDR-TB) :
    • It is caused by TB bacteria that are resistant to at least one of “isoniazid” or “rifampin”, the two most potent TB drugs.
  • Extensively Drug Resistant Tuberculosis (XDR-TB) :
    • It is caused by bacteria that are resistant to both “isoniazid” and “rifampin”, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).

Statistics of TB:

• India contributes to 27% of the global TB burden, the highest share globally.
• India’s TB incidence is 210 per 1 lakh population in 2021 which was 256 in 2015.
• About half of all people with TB can be found in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa.

Three Under-served Areas:

• TB vaccine :
  • The current TB vaccine, delivered at birth and useful particularly for children, is 100 years old.
  • The experience with the COVID-19 vaccine development process gives us an understanding on how things can be done if there is collective will and action.
  • It is also no surprise that Indian efforts feature prominently in the list of vaccines that are under development.
• Newer Therapeutic agents for TB :
  • This area - one that can move much faster than the vaccine - is that of getting newer therapeutic agents for TB.
  • After a development drought of nearly five decades, a few new anti-TB drugs are today available for widespread use, if only costs and production capacities weren’t constraints.
  • Moving to an injection-free and shorter all oral pills regimen for TB (the current standard is for at least six months) will improve compliance and reduce patient fatigue.
  • The effort to come up with a raft of newer drugs needs to accelerate so that when drug resistance shows up to the most recently introduced drugs - and it will, for this a battle for survival for the TB bacilli, and they are proven masters at surviving over millennia — we will have newer therapies available.
  • Current estimates of drug-resistant TB are discouraging at best and alarming at worst.
• Diagnostics :
  • There are exciting developments for use of AI-assisted handheld radiology with 90-second reporting and 95% plus accuracy for diagnosing TB.
    • This is mature technology, and should be rolled out universally immediately.
  • Sentinel, passive surveillance and interpretation of cough sounds for TB is another breakthrough area.
    • This allows for unobtrusive home-level screening and monitoring and provides nudges for seeking treatment.
    • This technology is ready for larger-scale use, and could potentially change the way public spaces can be monitored along with other air quality indicators.
  • Confirmatory diagnosis using nucleic acid amplification is ripe for disruption.
  • India convened the InDx diagnostics coalition in Bengaluru for COVID-19.
    • This, and other biotech startups, should be incentivised to break the complexity of molecular testing and price barriers with affordable high-quality innovations.
    • New innovations in this space should extend utilization of present funds available for purchase of TB diagnostics to buy twice as much.

Way Forward:

• India’s G20 presidency this year, the Varanasi StopTB board meeting this week, and the United Nations High-Level Meeting on TB in September this year provide the perfect platform for India’s actions to speak loudly and will enable the world to get to the end of TB sooner.
• India’s leadership of the G20 and the focus on health could be catalytic, in the same manner that the Japanese G7 presidency in 2001 was for the creation of the Global Fund.
  • Providing historical symmetry, Japan leads the G7 in 2023, providing leaders of both nations and groupings to act synergistically towards ending TB.
• Government should build accountability among health professionals and ensure sufficient and sustainable financing to provide access to prevention and treatment.
• All hospitals should create an after care system in which every TB case should be followed up regularly at periodic intervals.
• We must provide both treatment and legal literacy to people with TB, so that they understand their rights and can speak up if these are violated.

Conclusion:

• It is important to address the social conditions and factors which contribute to and increase vulnerability to tuberculosis.

Source: The Hindu

Mains Question:

Q. Discuss the under-served areas with respect to treatment of TB in India. Also, suggest measures for these areas. (250 Words).