On Wednesday, the tuberculosis (TB) global community will gather in New York for the first-ever high-level meeting (HLM) on TB at the United Nations General Assembly. The gathering will include people affected by TB and TB survivors, parliamentarians, business leaders, representatives from multilateral and global donor agencies as well as UN bodies, civil society leaders and, most crucially, heads of state with the power to make commitments on behalf of their countries.
TB has for long struggled with a visibility problem. Despite being one of the world’s deadliest infectious diseases killing over 1.5 million people every year and the leading cause of death among people living with HIV, TB has received less attention than it deserves.
This relative global neglect has had implications at multiple levels. There has been insufficient financial investment in TB by governments and minimal investment in tuberculosis R&D by pharmaceutical companies. This resulted in a gap of over 40 years when no new TB drugs entered the market (until fairly recently). Vaccine trials are ongoing but as of today, there is no vaccine for TB that can provide full protection from the disease. There have been few efforts to engage TB survivors, meaning that we have not heard first-hand the stories of those who have experienced the disease, nor witnessed the impact of their public testimonials.
But all this is steadily, if slowly, changing. Today, there is global commitment to ending TB, with targets of reducing TB deaths by 95%, reducing the number of new cases by 95% between 2015 and 2035 and ensuring that families do not bear the burden of catastrophic expenses as a result of TB.
Why India matters
India’s role in the global TB response cannot be overstated. Every day, an estimated 1,300 Indians die of TB, a disease that is curable and preventable. That means over 4 lakh deaths annually due to TB. Approximately 28 lakh people are diagnosed with the disease every year and India has a quarter of the world’s TB burden – meaning that for every 100 people with TB in the world, at least 25 are in India.
Accelerating the response to TB in India – thereby reducing the number of people affected by TB and deaths due to TB – will make a substantial dent in the global burden of the disease and contribute to reducing transmission of the disease. In addition, TB is both a consequence and driver of poverty and malnutrition, both of which will be positively impacted by controlling TB in the country.
The fact is that the world cannot dream of ending TB if India does not show the way. And India can.
Earlier this year, in March, the Indian TB community and global leaders gathered in Vigyan Bhavan in New Delhi and listened to Prime Minister Narendra Modi reaffirm India’s commitment to eliminating TB by 2025, five years ahead of the global targets (the Delhi End TB Summit even finds special mention in the HLM Political Declaration). A month prior to that, in the annual budget, the government announced the flagship Nikshay Poshan Yojana, a scheme to offer nutritional support to people with TB, with an initial outlay of Rs 600 crore. The Revised National TB Control Programme recently transitioned to a more patient-friendly daily treatment regimen and is also moving towards universal drug-susceptibility testing. There are pan-India efforts to engage the private healthcare sector. The engagement of TB Champions or Kshay Veers, whose involvement could be a gamechanger, is steadily growing. A few weeks ago, the first ever inter-sectoral meeting on TB was convened by the Ministry of Health and Family Welfare, bringing together senior bureaucrats and officials from over 15 ministries, reflecting a recognition of the socio-economic dimensions of TB and the global call for a multi-sectoral response to the disease.
Every single one of these actions is a step in the right direction. But for a comprehensive TB response, all of these pieces must come together and all the different actors must work together, at the same time.
On 26 September, when world leaders gather at the UN, the TB community will look to participation from India at the highest levels to reaffirm our commitment to ending TB by 2025. After the HLM, our every step will be watched keenly as we begin to translate our promises into action. Can we fulfil the commitments in the Political Declaration that will emanate from the HLM?
To quote from the Political Declaration, this means that over the next five years, India must work “to accelerate our national and global collective actions, investments and innovations urgently…” and ensure “access to affordable diagnostic tools and drug treatment, effective people-centred and community-based models of care”. For the world to meet the global target of “successfully treating 40 million people with tuberculosis from 2018 to 2022, including 3.5 million children”, India must diagnose and treat 11.19 million people, over 25% of the total target. Finally, India must commit to uploading the multi-sectoral accountability framework that is currently being developed.
The WHO may have formally declared TB a global emergency 25 years ago, but it is in 2018 that TB is finally getting the attention it demands and deserves. All eyes are on India, and we must deliver.
Anupama Srinivasan is a public health professional who works with REACH, a Chennai-based non-profit organization dedicated to the fight against TB for the last two decades.