TB Drug Shortage in India: Can India Achieve Its Goal of Eradicating TB by 2025

India is in the grip of a dire crisis—a life-or-death shortage of three critical tuberculosis (TB) drugs. The story began in 2022 with a shortage of Rifampicin, a vital drug for treating drug-sensitive TB patients. Today, this shortage has evolved into a menacing scarcity of drugs designed to combat drug-resistant TB, and the consequences are nothing short of alarming. When we talk about drug-resistant TB, we confront a formidable adversary. Conventional drugs like isoniazid and rifampin are powerless against certain TB-causing organisms. Multidrug-resistant tuberculosis (MDR TB) emerges when these organisms develop resistance to potent TB drugs. Patients battling MDR TB must turn to stronger medications like Linezolid, Clofazimine, and Cycloserine in their fight against this relentless disease.

India's situation is particularly dire. In 2021, the country accounted for a staggering 26% of global MDR TB cases, with a shocking 124,000 cases as of March 2021, according to the Government of India's annual report (1^✔ ✔Trusted Source
WHO Global TB Report 2022

Go to source).

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Taking TB Drugs: A Matter of Life and Death

Why should we be deeply concerned? The answer is stark: taking anti-TB drugs is a matter of life and death for those afflicted with tuberculosis. Ganesh Acharya, a TB/HIV survivor and activist from Mumbai, underscores that even a minor interruption in TB medication can lead to drug resistance. For individuals grappling with MDR TB, the stakes are graver. These patients already rely on a cocktail of multiple drugs every day to combat drug-resistant TB. Any disruption in this regimen can propel the disease into a more severe form, fueling community transmission.

Chapal Mehra, a public health activist, echoes these concerns. He paints a bleak picture of what this shortage could mean—patients discontinuing their treatment, seeking loans or financial aid for medication, experiencing heightened disease severity, and possibly facing discrimination and resentment.

But it's crucial to delve deeper into the impact on different segments of society. Consider income sources, dependencies, and socioeconomic disparities to gain a comprehensive understanding of the TB crisis in India.

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Don’t Push the Burden on States and Patients: A Call from Activists

"Don't Push The Burden On States & Patients," is the clarion call from activists. These drugs are typically supplied to patients through the National Tuberculosis Elimination Programme (NTEP). However, due to the shortage, the central government has shifted the burden onto individual states. Asha Frederick, Tamil Nadu State TB Officer, laments that states have been instructed to procure these drugs independently, without additional funding.

Activists like Ganesh Acharya question the wisdom of expecting patients to buy these drugs from private vendors when the government itself struggles to secure them. Many patients he interacts with cannot fathom affording these exorbitantly priced medications, further accentuating disparities in access.

Leena Menghaney, a lawyer specializing in medicines, law, and policy, drives home the urgency of an uninterrupted drug supply for TB patients. She emphasizes the need for efficient procurement systems, transparent handling of shortages, effective reporting by healthcare workers and patient groups, and more accurate forecasting to stave off drug shortages.

TB survivors are demanding action to avert future drug shortages, calling for reinforced drug forecasting, procurement, and supply chain mechanisms. They propose the establishment of Stock Monitoring Committee comprising NTEP officials, supply chain experts, and TB community representatives.

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Elimination of TB in India by 2025: A Dwindling Vision?

Eliminating TB in India by 2025 was a grand vision set by the government. Yet, the path to this lofty goal is fraught with challenges. TB remains a formidable adversary, causing significant morbidity and mortality. The burden includes multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB).

MDR-TB prevalence is high among both new and previously treated patients, with a dishearteningly low diagnosis and treatment success rate. The specter of XDR-TB looms ominously, with increasing instances in India. Achieving the 2025 target seems improbable given the monumental TB challenge and the complexities of MDR-TB and XDR-TB.

To inch closer to this audacious goal, all stakeholders must unite in a concerted effort. The government must substantially boost funding for the Revised National TB Control Programme, roll out daily fixed-dose regimens nationwide, adopt new diagnostic technology and anti-TB drugs, and engage the vast private sector, which handles at least 50% of TB cases. We need to remember that Tuberculosis (TB) is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent, ranking above HIV/AIDS. This fact highlights the significant global impact of TB as a major public health concern.

Revamping the healthcare system, ensuring effective surveillance, and providing comprehensive support to TB patients are also imperative. The journey to eliminate TB is long and arduous, but with collective efforts, it is not beyond reach. Without such unity, the dream of ending TB in India may remain elusive, and the nation will grapple with the dire challenges posed by TB and drug shortages (2^✔ ✔Trusted Source
2025 too short time to eliminate tuberculosis from India

Go to source).

This brings us all down to one question:

How can India and the global community effectively address the alarming rise of MDR TB cases and ensure access to life-saving medications in the face of such a critical public health crisis?

References:

1. WHO Global TB Report 2022 - (https://pib.gov.in/PressReleasePage.aspx?PRID=1871626)
2. 2025 too short time to eliminate tuberculosis from India - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592749/)

Source-Medindia