24 March 2023

Table of Content

World TB Day 2023-How India Plans to Achieve Its Target of Eliminating Tuberculosis By 2025

GS-2 Social Justice:

India has set a target to eradicate tuberculosis by 2025, which is five years earlier than the global target. As a result, researchers are expediting the testing of newer vaccines and shorter treatment courses. Meanwhile, the government is prioritizing active case detection, entrepreneurs have helped increase testing capacity, and the community has offered nutritional support to patients. 

In honour of World TB Day 2023, Prime Minister Narendra Modi will speak at the One World TB Summit, where he is anticipated to unveil initiatives to help India achieve its 2025 target. This year's theme, "Yes! We can end TB!", also aligns with India's objective.

Tuberculosis

• Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. 
• The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. 
• Not everyone infected with TB bacteria becomes sick. 
• As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease.
• If not treated properly, TB disease can be fatal.
• Treatment for TB usually involves taking antibiotics for several months.
• TB Vaccine:

• Bacille Calmette-Guerin (BCG) is a vaccine for TB disease. 
• However, it is often given to infants and small children and it does not always protect people from getting TB.

The Tuberculosis Situation in India: A Closer Look

• India remains the biggest contributor to global TB cases, but there has been a decrease in the number of cases in 2021.
• Reportingof TB cases has also improved in 2021, bouncing back from the lows seen during the first year of the pandemic, as stated in the Global TB Report 2022.
• The incidence of TBdecreased by 18% in 2021 compared to the 2015 baseline, dropping to 210 cases per lakh population from 256 cases per lakh population. 
• The incidence of drug-resistant TB also decreased by 20% from 1.49 lakh cases in 2015 to 1.19 lakh cases in 2021.
• According to the Global TB Report 2022, India accounts for 28% of all TB cases in the world, with 21.3 lakh cases detected in 2021, compared to 18.05 lakh cases in 2020.
• The numbers are still lower than the 24.04 lakh cases reported before the pandemic in 2019, according to data from the government's Ni-kshay portal, which helps in real-time reporting of new TB cases.
• A survey conducted across 20 states showed that the incidence of TB was higher, at 312 cases per lakh population.

India’s TB elimination target

• Elimination of TB by 2030 is a sustainable development target set by the world, but India has set the target for 2025.
• The national strategic plan 2017-2025 aims for India to report no more than 44 new TB cases or 65 total casesper lakh population by 2025, with the estimated TB incidence for 2021 standing at 210 per lakh population.

• Achieving this target is challenging as the plan had envisioned an incidence of only 77 cases per lakh population by 2023.

• The programme also aims to reduce TB mortality to 3 deaths per lakh population by 2025, with the estimated TB mortality for 2020 standing at 37 per lakh population.
• The plan also aims to reduce catastrophic costs for affected families to zero, but the report states that 7% to 32% of those with drug-sensitive TB and 68% with drug-resistant TB experienced catastrophic costs.
• The goals are in line with the World Health Organisation's End TB strategy, which aims for an 80% reduction in the number of new cases, a 90% reduction in mortality, and zero catastrophic cost by 2030.

Government Initiatives towards Eliminating Tuberculosis

• The government has taken several steps to achieve the TB elimination target of 2025, including actively looking for cases among vulnerable and co-morbid populations, screening at health and wellnesscentres, and calling on the private sector to notify all TB cases.
• An online Ni-kshay portal has been set up to track notified TB cases.
• The pandemic has led to improved access to more accurate molecular diagnostic tests like CB-NAAT and TureNat. 

• Presently, there are 4,760 molecular diagnostic machines available, covering all districts of the country. 
• In addition, 79 line probe assay laboratories and 96 liquid culture testing laboratories have been set up for the diagnosis of multi and extremely drug-resistant TB.

• The government has implemented a universal drug susceptibility test to determine antibiotic susceptibility of the mycobacterium for all newly diagnosed cases. 

• Earlier, patients were started on first-line treatment and were tested for drug resistance only if the therapy did not work. 
• Conducting a drug susceptibility test at the outset ensures that patients are given effective antibiotics from the beginning.

• The government launched the community engagement program last year, where Ni-kshayMitras can adopt TB patients and provide them with monthly nutritional support. So far, 71,460 Ni-kshayMitras have adopted about 10 lakh TB patients under the program.

Advancements in Treatment Protocols

• The government's free basket of drugs provided for TB patients now includes newer drugs such as Bedaquiline and Delamanidfor treating drug-resistant TB.

• These oral drugs can replace the injectable kanamycin, which was associated with serious side effects like kidney problems and deafness.
• The new drugs have also been added to the National List of Essential Medicines, which gives the government power to regulate their market price.

• Researchers have been studying shorter courses of anti-tubercular drugs, such as three- and four-month courses, as an alternative to the existing six-month therapy.

• At present, Anti-tubercular drugs need to be taken for six months to over two years depending on the susceptibility of the mycobacterium.
• The long duration of treatment often results in people dropping out in between, increasing the likelihood of them developing drug-resistant infections later.

Upcoming Vaccines Under Development in the Pipeline

• Researchers are searching for new ways to prevent tuberculosis infection, almost a century after the development of the existing BCG vaccine.
• The BCG vaccine uses a weakened form of the TB bacteria to train the immune system, but its protection is limited and not very effective against the most common form of TB in the lungs. It also doesn't prevent infection or reactivation of a latent infection.
• Trials are underway to test the effectiveness of a vaccine called Immuvac, initially developed to prevent leprosy, in preventing TB. The vaccine uses mycobacterium indicus praniiwith antigens similar to those of leprosy and TB bacteria.
• Researchers are also testing a vaccine candidate called VPM1002, which is a recombinant form of the BCG vaccine modified to express TB antigens better, resulting in better training of the immune system and protection against TB.
• Researchers are also studying whether the existing BCG vaccine booster shot should be given to household contacts of a person with active tuberculosis.

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