India must ‘quadruple spending’ on TB care

Ahead of the World Tuberculosis Day on March 24, a country-wise report card released by The Lancet states that India is not on track to achieve the elimination goals and that its methods to tackle drug-sensitive and multi-drug resistant TB need improvement. Also, national public sector financing needs to improve and catastrophic health expenses incurred by TB patients need to be reduced.

“India can increase domestic expenditure on TB by 400 per cent over the next five years by increasing the distribution of public resources to health, pooling financing and allocating tax revenues to health,” the report states.

Currently, India has allocated close to ₹4,000 crore for tackling TB, but the report says this is not enough.

In 2017, India had 204 TB cases per one lakh population. India aims to eliminate TB by 2025, Prime Minister Narendra Modi had announced.

In 2017 alone, India saw 4.21 lakh TB deaths.

An additional 80 lakh lives can be saved in India by subsidising tests and supporting patients to complete treatment, the report estimates based on modelling studies.

The disease burden

India has the highest TB burden in the world and predominantly patients tend to go to private health-care. The paper states, “More than one-quarter (28 per cent) of TB deaths could be averted over the next 30 years (an additional 80 lakh lives). This would cost an extra $290 million each year, which is less than India’s $32 billion losses associated with TB mortality each year.”

Apart from India, other high-burden countries include Bangladesh, Congo, Indonesia, Kenya, Mozambique, Nigeria, Pakistan, South Africa and Tanzania.

Minister of Health and Family Welfare JP Nadda said in a comment in the research paper that to end tuberculosis, governments of high-burden countries will need to propose bold plans to address tuberculosis rather than be content with moderate incremental gains.

Nadda said, “The Lancet Commission reports the value of the loss associated with tuberculosis mortality to be an estimated $32 billion per year in India. New tools resulting from greater tuberculosis research and development (R&D) are essential to prevent those projected economic losses.”

He further said, “With at least 30 per cent of India’s population infected with tuberculosis, we need accurate point-of-care diagnostics for detecting tuberculosis infection and effective person-centred treatment. We need an effective vaccine to prevent tuberculosis. Delivering strong advocacy, in close coordination with the Ministry of Science and Technology and research-oriented pharmaceutical companies, and global commitment and collaboration to tuberculosis R&D are essential to reach our targets.”

However, even if current treatments were extended to 90 per cent of people with TB, and 90 per cent were successfully cured, existing efforts would have failed to avert 800,000 deaths in 2017. Global research investment needs to increase by up to four times (from $726 million in 2016) to develop treatments and prevention tools that would transform TB outcomes, the paper states.

“The initial global costs to reduce TB deaths by 90 per cent (from 1.7 million per year to less than 200,000 a year) could be in the order of $10 billion a year, and investments would need to increase by about $5 billion a year initially. However, this would be followed by reduced costs (diminishing to $1-2 billion a year by the early 2040s) as the number of new cases reduces,” the paper estimates.