Refocus on TB

The world got a wake-up call in 1993 about tuberculosis (TB) when the World Health Organization declared it a global health emergency. The 1993 World Development Report labelled TB treatment for adults as the best buy among all developmental interventions. The response in the 30 years since has been short on urgency and long on processes. The current goal is to end TB by 2030, but clarity on definitions of ‘end’ and the means of verification are not fully in place.
India has one of the highest tuberculosis (TB) burdens in the world. According to the World Health Organization's Global TB Report 2021, India accounted for about one-quarter of the global TB cases in 2020. The estimated incidence of TB in India in 2020 was 2.64 million cases, which is higher than any other country. The burden of TB in India is compounded by factors such as poverty, malnutrition, overcrowding, and a high prevalence of HIV/AIDS. Additionally, the emergence of drug-resistant TB strains further complicates the situation.
The Indian government has implemented several initiatives to combat TB, including the Revised National Tuberculosis Control Program (RNTCP) and the National Strategic Plan for Tuberculosis Elimination. These efforts have led to increased case detection and improved treatment outcomes, but more needs to be done to achieve the goal of TB elimination in India. Despite constraints, the global TB response has been adapting to changes: the HIV response has inspired ‘engagement’ of those affected by the disease; the use of molecular diagnostic tools developed to respond to acts of bioterrorism 20 years ago are the current state of the art for diagnosing TB. Using social safety programmes to address the poverty drivers of the TB epidemic and leveraging the “mobile and computational data revolution” to improve treatment outcomes have also begun shaping the trajectory of global efforts to end TB.
There are three key areas that remain under-served. The development and wide use of an adult TB vaccine is vital. The current one, delivered at birth and useful particularly for children, is 100 years old. The second is development of new anti-TB drugs. Moving to an injection-free and shorter all oral pills regimen for TB (the current standard is for at least six months) will improve compliance and reduce patient fatigue. The third and most immediate area of action is within the space of diagnostics. There are exciting developments for use of AI-assisted handheld radiology with 90-second reporting and 95% plus accuracy for diagnosing TB. This is mature technology, and should be rolled out universally immediately.
Without strengthening or radically re-imagining them, the chances of success in ending TB by 2030 become slimmer.