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WHO Global TB Report
Context:
The latest Global Tuberculosis (TB) Report by the World Health Organisation (WHO) reveals that India continues to bear the highest burden of TB globally.
Tuberculosis (TB)
- It is a serious infectious disease that primarily affects the lungs.
- Caused by the bacterium Mycobacterium tuberculosis.
- It spreads through the air when an infected person coughs, sneezes, sings or speaks.
- Symptoms: It includes a persistent cough (lasting more than three weeks), chest pain, fever, night sweats, weight loss, and fatigue.
- Diagnosis: Chest X-ray, Sputum test, Tuberculin skin test (TST), interferon-gamma release assay (IGRA), Molecular tests.
- Treatment: It is treatable with a standard regimen of antibiotics lasting approximately six months, which typically includes a combination of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol for active infections.
- For latent TB infections, preventive treatment may involve a shorter course of antibiotics. Treatment adherence is crucial; incomplete treatment can lead to drug-resistant strains of TB, which are more difficult and expensive to treat.
Global and National TB Trends in 2023:
- Global Increase in TB Diagnoses: Worldwide, 82 lakh people were newly diagnosed with TB in 2023 — the highest recorded number since WHO began monitoring TB globally in 1995.
- This marks a resurgence, with TB again becoming the leading infectious killer, surpassing Covid-19 in 2023.
- India’s TB Cases: India continues to account for a quarter of the global TB burden. The estimated number of TB cases in India for 2023 stands at 28 lakh, representing 26% of the global TB cases.
- Increase in Reported Cases: The number of reported TB cases in India grew to 25.1 lakh in 2023, marking a positive sign that diagnostic gaps are closing, with better detection and reporting. India and Indonesia together accounted for 45% of the increase in TB diagnoses between 2021 and 2023.
- Decline in TB Deaths: India saw a slight decline in TB deaths from 3.31 lakh in 2022 to 3.2 lakh in 2023. However, the country still accounts for 29% of global TB-related deaths.
India’s Progress Toward WHO Targets:
- Elimination Goal: India aims to eliminate TB by 2025, five years ahead of the global target. However, progress has been slower than desired.
- Decline in TB Cases: India has seen an 18% decline in TB cases between 2015 and 2023, falling short of the 50% decline target set for 2025.
- Decline in TB Deaths: TB-related deaths have reduced by 24% in India, which is also below the target of 75% reduction by 2025.
- Multi-Drug Resistant TB: India accounts for 27% of the global multi-drug resistant tuberculosis (MDR-TB) burden in 2023, underscoring the challenge of combating drug-resistant strains.
Treatment Coverage:
- High Treatment Coverage: A positive development is that 85% of those diagnosed with TB in India were put on treatment, placing India among the top countries for high treatment coverage among the 30 highest-burden TB nations.
- The significant increase in reported cases is largely due to better diagnosis and a more robust system to ensure treatment adherence.
Challenges:
- Funding Gaps: The Global TB Report highlights a massive funding gap, with only $5.7 billion of the $22 billion needed to combat TB being available in 2023.
- Shrinking Domestic Funding in India: The report also shows a concerning trend in India’s domestic funding for TB. From $432.6 million in 2019, funding dropped to $302.8 million in 2023.
- This includes a reduction in domestic contributions, which decreased from $345.9 million to $253 million in the same period.
- Shrinking Domestic Funding in India: The report also shows a concerning trend in India’s domestic funding for TB. From $432.6 million in 2019, funding dropped to $302.8 million in 2023.
- Catastrophic Health Costs: One of the most concerning findings in the Global TB Report 2023 is the issue of catastrophic health costs for TB patients and their families.
- Global Comparison: Globally, 49% of households with TB are facing such catastrophic costs, far exceeding the WHO’s End TB Strategy target of zero. India’s figure is significant when compared to neighbouring countries, such as:
- Thailand: Around 1% of the population faces catastrophic costs.
- Pakistan: Around 5% of the population.
- Bangladesh: Around 25% of the population.
- Global Comparison: Globally, 49% of households with TB are facing such catastrophic costs, far exceeding the WHO’s End TB Strategy target of zero. India’s figure is significant when compared to neighbouring countries, such as:
Way Forward:
- Close Gaps in Diagnosis and Treatment: India has made notable strides in improving TB detection and treatment, but it still faces challenges in reducing the number of cases and deaths to meet its 2025 elimination goal.
- Funding and Resource Allocation: There is a pressing need to increase both domestic and international funding for TB control, ensuring that the necessary resources are available to implement effective treatment and prevention programs.
- Addressing Catastrophic Costs: The financial burden on families must be reduced. This can be achieved by improving access to affordable TB treatment, enhancing social protection programs, and ensuring that TB care does not push households into poverty.
- Strengthening Research and Innovation: Investment in new TB diagnostics, treatments, and vaccines must be prioritised. The growing problem of multi-drug-resistant TB requires new approaches to drug development and a stronger emphasis on research and development.
- Collaboration and Coordination: Greater collaboration between the government, international organisations, and private stakeholders is crucial. India’s national TB programs must align with global strategies, ensuring that the country’s efforts contribute to the broader goal of TB elimination worldwide.
