In today's Finshots we talk about India's battle against Tuberculosis and how the government intends to fight it

The Story

The ‘National Tuberculosis Prevalence’ survey, the first of its kind since the 1950s, was released in India this year. And it had some shocking revelations:

  1. India has 312 TB cases per 1 lakh population (above the age of 15) compared to a global average of 127 per lakh of people.
  2. Over 64% of the population who had been diagnosed with TB symptoms didn’t seek healthcare.

Now this is a big problem because without proper care and attention, TB can be fatal. The bacteria affects the lungs and if people don’t seek medical intervention (like the 64%), the problem can get out of hand. It can quickly progress to other vital organs — kidneys, brain, and spine. And for a country that is home to over 31% of all TB patients, we end up losing $32 billion every year due to the disease. We’re talking about the economic loss due to a drop in productivity of affected families.

And despite our ambitious goal of making the country TB free by 2025, the progress has been slow so far.

To combat this malaise, the Indian government launched the Pradhan Mantri TB Mukt Bharat Abhiyan scheme last week. And like many of its other schemes, it’s a collective action effort. The government has realized that it cannot fight the problem alone. It’s calling on NGOs, corporates, individuals and elected representatives to come forward as donors to assist TB patients in their journey towards recovery.

But how did India’s TB situation get so dire?

Well, everyone has a different opinion on the matter. For starters, India was one of the first developing countries to set up a dedicated TB programme in 1962. But some experts say that the country has under-invested in TB control for decades. Take this stat for instance — even though the government provides free diagnosis and treatment to TB patients, over 70% of patients turn to private hospitals for treatment and diagnosis. This is because public hospitals are understaffed and overburdened with cases.

Now the problem happens when the private sector does not report TB cases on the national portal. There is no proper follow-up or adherence to the treatment regimen and people end up getting infected by TB multiple times. The end result? The emergence of even more severe cases of multi drug-resistant TB (MDR-TB). India has become the hotspot for such TB cases in the world.

And diagnosis and treatment of such cases is hard. Even the costs are exorbitant.

One of the prescriptions for multidrug-resistant TB is a relatively new antibiotic called Bedaquiline. But not everyone has access to it. And that’s because of its price. You see, a 6-month course of this antibiotic costs the government over ₹25,000. And that’s due to a patent on the drug held by pharma giant Johnson & Johnson. Another drug called Delamanid costs nearly ₹1 lakh per patient. Again, due to a patent held on it.

These are not costs that the government can easily bear.

But there also might be something else that doesn’t get talked about enough — how undernutrition feeds into TB.

You see, TB bacteria can actually live in your body without infecting you or making you sick. It’s called latent TB. You don’t transmit the disease to others as well. And it’s estimated that 40% Indians carry latent TB. But here’s the thing about latent TB. Individuals who are undernourished are more likely to see this develop into active TB compared to those with a healthy body weight.

And by some estimates, undernutrition accounts for almost 55% of India’s yearly tuberculosis cases.

There’s also the side-effects of undernutrition. You see, the medicines prescribed for TB patients aren’t like your everyday paracetamol or any other OTC drugs. These are strong antibiotics that have to run a course for 6 months and even longer. And many patients who belong to poorer sections of society stop their treatment because their bodies are severely malnourished. Their bodies just can’t cope with the side effects of these medicines. This then leads to multiple other problems. Such patients often complain of a loss of eyesight, constant fatigue, and severe weakness in limbs. And you can imagine what this does to their productivity cycle and economic situation.

Now India has the Nikshay Poshan Yojana to provide TB patients with a Direct Benefit Transfer of ₹500 every month for their nutritional needs. But considering the recommended calorie intake of 2,800 kcals a day by the National Tuberculosis Elimination Programme for TB patients, ₹500 just doesn’t cut it. Also, there have been many complaints about the payouts from the scheme itself — including delays in payments or its non-receipt and demand for excessive documentation too.

So yeah, maybe a collective action effort is the need of the hour. Maybe a rallying cry can bring together India’s MNCs who could put their funds to good use. After all, the government is trying to get people and companies to adopt TB patients — by committing monetary support for 1–3 years. Out of the 13.5 lakh TB patients registered on the government portal, 8.9 lakh of them have given their consent for adoption.

With nearly 1 person dying of TB every minute in the country, hopefully, we can end the scourge of TB soon enough.

Until then…

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