World Health Organisation's (WHO) flagship Global TB Report 2016, released on Oct 12 considers India as the most vulnerable country to this infectious disease. The report comes up with a revised estimate of the new TB cases in India to 2.8 million in 2015 as compared to 2.2 million in 2014.
The severity of the challenge can also be found with a whopping 480,000 people losing their lives to this disease in the country, which is about a quarter to the total of 1.8 million deaths globally.
The new report is a wake-up call for India to break the status-quo in how TB and its drug-resistant forms are being diagnosed and treated. India is also among other five countries (Indonesia, China, Nigeria, Pakistan and South Africa) accounted for 60% of total new TB cases.
The most worrying fact that comes up as a threat to tackle this challenge is the low rate of decline in TB incidence, which has remained static at 1.5 per cent from 2014 to 2015. This low decline rate needs to be scaled up to the level of 4% to 5% annually by 2020 to reach the first milestone to end the TB strategy.
The new report comes out very strongly revealing the gaps in testing for TB and reporting new cases as there are 6.1 million of the estimated 10.4 million new cases detected and officially notified, leaving a huge gap of 4.3 million.
This problem is surfacing because of under-reporting of TB cases, particularly in a country like India, where there are quite a high number of unregulated private sectors, who are mostly not reporting TB cases and large instances of under diagnosis because of inaccessible care.
480,000 people diagnosed with MDR TB in 2015 with India, China and Russia, accounted for more than 50% of such cases globally. Unfortunately, one out of five people have only got the access to second line treatment and overall global cure rates of MDR-TB continue to remain low at about 52%.
Ten countries account for 77% of the total estimated gaps between incidence and notifications, with India, Indonesia and Nigeria alone accounting for over 60% of the gaps between enrolment on MDR TB treatment in 2015 and the estimated number of incident MDR/RR TB cases in 2015.
Globally, 7234 patients with XDR-TB were enrolled for the treatment (more than twice the level in 2014). Most of these cases in 2015 were notified by India (2130), Ukraine (1206), Russian Federation (1205) and South Africa (719).
Treatment success rate of MDR TB cases was more than 50% in countries with the largest cohorts; India, Philippines, Russian Federation, South Africa and Ukraine. This is primarily due to high death rate in India, South Africa and Ukraine, high treatment failure rates in the Russian Federation and Ukraine and high rate of loss of follow up or missing data in India, Philippines and South Africa.
Among six countries with XDR- TB cohorts of more than 100 individuals, mortality was highest (less than 40%) in India and South Africa.
The WHO official note also brought out a new way of advocacy effort with government. According to the new observation, Minister of Health is not the right person to speak in the government, rather all efforts should be directed to the Finance Minister and Prime Minister in high TB burden countries like India.
The report comes as an early warning for India to tackle this epidemic. India has to show its strong political commitment and allocate more funding to check this disease.
The country can no longer afford to allow the poor dying of TB and remain silent leaving many undiagnosed and untreated and create the cycle of TB transmission and death. This has to stop.