In TB reality check, Lancet report says Indian, global goals unrealistic

  • A tuberculosis-free world is possible only by 2045 and not 2030, the target year set by UN SDGs to end the epidemic, says a Lancet report
  • Countries with high disease burden need to ensure that quality diagnostic tests and treatments are available, says the report

New Delhi: A tuberculosis-free world is possible only by 2045 and not 2030, the target year set by the United Nations Sustainable Development Goals (SDGs) to end the epidemic, said a report in British medical journal Lancet.

A co-author of the Lancet report also said that India’s goal to end the epidemic by 2025 was too “ambitious" , “unrealistic", and, therefore, unattainable.

According to the World Health Organization’s “Global Tuberculosis Report 2018", India accounted for 27% of the 10 million people, who had developed TB in 2017, besides making up 32% of global TB deaths among HIV-negative people, and 27% of combined TB deaths.

The disease remains a major public health challenge, and was responsible for 1.6 million deaths worldwide in 2017.

The Lancet report was optimistic about ending TB, but not before 2045.

Nalini Krishnan, one of the co-authors, said: “Eliminating TB by 2025 is a laudable vision, but difficult to achieve, considering the complexities of managing the situation, which requires equitable high quality of care to every person from diagnosis to treatment, cutting the transmission rapidly with a combined strategy of early diagnosis treatment of latent tuberculosis infection (LTB) and improving socioeconomic conditions."

“All this, though envisaged in the NSP (National Strategic Plan prepared by the centre in 2017), needs accelerated action, accountability and a dynamic strategy that is responsive to real-time data. Even with this kind of effort it would be hard to achieve these goals," she added.

The report, however, suggests that India could avert more than a quarter of TB deaths in the next 30 years by subsidizing tests and supporting patients to complete treatment , besides engaging private sector healthcare providers.

The UN’s special envoy on TB, Eric P. Goosby, said that if India does not act, unavoidable deaths will make a dent on its economy. “In India, optimizing private sector engagement could avert eight million deaths between now and 2045. In addition to the lives lost, even with optimal implementation of all existing tools, unavoidable deaths will cost the Indian economy at least $32 billion each year for the next 30 years," Goosby said in an emailed response.

According to the Lancet report, increased political will, financial resources and increasing research to develop new ways to diagnose, treat and prevent TB will help achieve the goal.

The Lancet Commission on TB was published ahead of World TB Day on 24 March.

The report estimates that there are significant financial benefits of reducing TB mortality—the savings from averting a TB death are estimated to be three times the costs, and may be much greater in many countries.

Goosby said that India’s progress is extremely important in fight against TB. “India has the highest TB burden in the world. Given our inter-connected world and the airborne spread of TB, we need collective global action. Ending TB in India will have massive global impact in addition to saving the lives of tens of millions of India’s people over the next 25 years".

The report highlights the importance of combatting drug-resistant forms of TB, threatening control efforts in many parts of the world. In 2017, around a quarter of the world’s population were living with TB infection, it said.

Ironically, the report suggests the existing treatment is not enough to save lives. According to the report, even if current treatments were extended to 90% of people with TB, and 90% 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 US$726 million in 2016) to develop treatments and prevention tools that would transform TB outcomes".

The report is a roadmap for high-burden countries accountable for defeating TB. According to the report, currently more than a third of TB cases (35%) are not diagnosed or treated.

The authors call for universal access to drug susceptibility testing at diagnosis to ensure that all patients are given appropriate treatment, including access to second-line treatment for drug-resistant TB.