Global fears over India’s ticking TB time bomb

  • Technology, Published on: Friday 11th November 16 - 10:51am

The international public health community wants India to act urgently to tackle TB resistance, currently spreading at an alarming rate in the country

Eighteen months after the Indian government launched the “TB Free India” campaign, nine policy changes in the national programme are yet to be implemented. The delay has raised concerns among the international public health community, which believes that drug-resistant tuberculosis (TB) — currently spreading at an alarming rate in India — will not remain confined to the borders if the Indian government does not show urgency.

The main gaps are regarding the government’s failure to roll out Fixed Dose Combinations (FDCs) for TB patients living with HIV due to delays in tender; the failure to provide child-friendly TB regimen and the glacially slow pace of scaling up availability of the new drug Bedaquiline, which can treat multidrug-resistant TB (MDR-TB). Six months after launching the drug, only 36 MDR TB patients have been enrolled in Delhi.

High disease burden

According to the World Health Organization (WHO), India shoulders the maximum number of TB patients — 2.84 million Indians contracted the disease in 2015 alone. “India is home to the most serious ‘hotspots’ of MDR-TB transmission, especially in cities like Mumbai. The resistant form of TB is spreading in India at alarming levels, but since TB is airborne, it is not confined within the borders of the country, and the high rates of MDR-TB in India spell trouble for the Southeast Asian region and beyond. India must do whatever it can to stop transmission of TB both within and beyond its borders,” said Prof. Jennifer J. Furin of Harvard Medical School.

Lack of Indian delegates at the 47th Union World Conference on Lung Health in Liverpool, U.K. has raised further questions about India’s commitment to meet global TB targets. Dr. Mario Raviglione, Director of the Global Tuberculosis Programme at the WHO, said, “If India does not move, the world does not move. We cannot do much without India as they have nearly 30 per cent of the TB cases there.”

India’s apathy

With an objective to send an ‘urgent’ message to Indian Prime Minister Narendra Modi, activists interrupted the only session attended by an Indian Health Ministry official at the conference last week, reading out a list of demands to address the gaps in implementation. The delay has resulted in a campaign called #BrokenTBPromises — which counts each day until Mr. Modi addresses the issue.

However, Dr. Jagdish Prasad, India’s Director General of Health Services, stunned the international delegates by calling protesting activists “mentally unstable” during the session. When probed about the delay in rolling out TB drugs, he said, “In India, when a son wants to marry someone's daughter, it takes over 6 months to arrange the marriage. It is same with policies. We do not want to discuss our internal problems in a foreign country.”

The situation in India is very troubling for us in the international community, said Dr. Furin. “Fewer than 100 people in India have been able to access this treatment is appalling,” added Dr. Furin, who was one of the protesters. “The continued unwillingness of the Indian government to provide adequate treatment and prevention tarnishes India’s reputation on the international stage. We are respectful of our colleagues in India who are working hard within the system but when they don’t come to conferences like these, it seems like they don’t want to acknowledge the reality of the disaster that TB and DR-TB is in India. I think it is time for the international community to stop being polite with India because the news that comes out of India is worse and worse every time,” she added.