Lt Gen (Retd.) Dr. Prof, BNBM Prasad,SM,VSM,PHS
Former DGHS(AF).
In 2014 W.H.O. came out with a bold initiative namely ‘End TB by 2030’ that envisages reduction in the incidence of active TB cases to negligible levels by enhancing time tested strategies aimed at quality diagnosis and effective treatment. ‘End TB’ does not mean end of TB from the globe. It is the most vital step in reaching the ultimate target that is to eradicate TB like small pox once for all by the year 2050 which means both zero TB incidence and TB mortality respectively.
End TB strategy that is endorsed by the W.H.O. aims to achieve 90% reduction in TB deaths and 80% reduction in the incidence of active cases respectively by 2030 with none of the TB affected have to face the catastrophic costs due to disease per se. This Paradigm shift in the approach from TB containment to TB elimination by strengthening the hither to for diagnosis and treatment modalities was the need of the hour. The resurgence of TB epidemics in several parts of the world especially in Africa and South East Asia during the early nineties due to dual infection of HIV and drug resistant TB, was a grim reminder of impending disaster. Many communities in sub-sahara Africa perished in no time due to deadly duo of TB and HIV. It was a global emergency and the time to act by emergent measures.
TB is an age-old disease which has spared none- rich and poor alike affecting several millions across the globe from the time immemorial. It was a ‘Captain Among Men Of Death’ and even today continues to be a significant cause of mortality. After thousands of years of ignominy, the epoch-making discovery of TB bacillus that is central to TB pathogenesis, by the legendary German Microbiologist on 24 March 1882, paved the way for developing appropriate diagnostic tools and anti-TB drugs respectively that could treat the disease most effectively. In this era of genomics, things have become easy notwithstanding significant incidence of drug resistance and comorbidities among TB patients. TB once incurable is now curable. Eradication of TB from the globe is in sight.
TB is a poor man’s disease and TB patients should not be burdened by financial and social costs incurred due to the TB disease per se. TB control measures failed miserably in resource poor countries due to inherent systemic deficiencies. India has been worst affected despite TB control programme is in vogue since long. With nearly 3 lakh deaths annually and 2.5 million cases with significant number among them harboring drug resistant TB germs (1.10 lakh), TB elimination continues to be a distant reality notwithstanding the concerted efforts by the determined Modi Govt. to ‘End TB by 2025’
No doubt under the national TB elimination programme (NTEP), significant progress has been made to reduce TB in India. There has been a drastic dip in both mortality and annual incidence of new cases but it is not good enough to reach the self-set’ targets in India.Covid-19 pandemic was a big setback to TB control in India and efforts are on to accelerate the pace of TB Control measures to regain the lost ground due to the deadly pandemic.
TB is a chronic disease and for its eradication from the roots, a fully committed leadership is a must with involvement of both the private and public players in unison. The importance of providing universal access to high quality diagnosis and treatment including drug resistant cases free of cost need no emphasis for the success of TB control measures. Quality management that includes early diagnosis, prompt therapy including drug resistant cases and chemo-prophylaxis of the latent cases, has worked well. Many western countries where TB once a significant public health concern has become a rarity, thanks to stringent implementation of TB care that is comprehensive and holistic.
End TB by 2030 is achievable provided 3 pillars of ‘End TB Strategy’ namely patient centered care and prevention, bold policies and supportive systems and intensified research and innovation are strictly enforced in letter and spirit with renewed intensity and pace to match the demand. Upscaling the existing facilities as well as accelerating the pace of implementation are the need of the moment.
TB is a complex disease and a great masquerader of many systemic illnesses, warranting a sound understanding of the disease for effective management. India has a significant TB burden and Indian requirements are different. The nation should evolve her own health care system that is preventive as well as curative. Quality TB care is a must and so also research and medical education. All concerned especially medical personnel should be fully conversant with complexities of TB management. Medical graduates play a pivotal role in TB control in the community. It is mandatory that both the science as well as the art of TB Medicine practices should be taught at the undergraduate level. Over the years the practice of TB Medicine TB has lost the luster. Many Chest Physicians prefer much lucrative interventional Pulmonology over TB care that requires patience and total commitment. Treating a TB patient is highly satisfying to the Clinician unlike managing an end stage lung disease where any amount of intervention is sure to fail. Developing state of the art TB centers in different parts of the country to meet patient requirements is a must. Concerted efforts to develop cheap TB drugs and vaccine have to continue unhindered.
If we don’t act decisively, we are going to perish. India has nearly 40 percent latent cases which can explode to full blown active TB in no time. Prevalence of co-morbidities like malnutrition and diabetes are on rise. They add fuel to the simmering TB fire. It is worrisome so also environmental pollution which make TB control extremely difficult. It is a wakeup call and all the loop holes in existing health care needs to be plugged to make India really TB free. Task is tough and it is the tough who keeps going. India has to set the agenda and lead by example as the country did during Covid-19 pandemic. Let us pledge to make India a global leader in TB eradication as we celebrate World TB Day to commemorate the discovery of TB bacillus.
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