Pushed to a corner owing to lack of political will on the part of countries with a high burden of tuberculosis, the World Health Organisation has called for the first United Nations General Assembly session on the disease. The fight against TB cannot be won as long as the high-burden countries, particularly India which has the highest TB burden in the world, do not galvanise their government machinery effectively. While the number of deaths caused by TB and the incidence rate had been consistently dropping from the historical highs globally, there has been a recent uptick that is much larger than previously estimated. The primary reason is the sharp increase in the incidence estimate from India — from 2.2 million cases in 2014 to 2.8 million in 2015. Ironically, the revised disease burden estimate for India is an “interim” one; the actual burden, which could be much higher, will be known only when the national TB prevalence survey that is scheduled to begin next year is completed. The number of estimated deaths caused by TB more than doubled from 220,000 in 2014 to 483,000 in 2015. As in the case of incidence, the revised estimate for deaths could also be an underestimation.
The increase in incidence owes to a 34 per cent rise in case notifications by health-care providers in the private sector between 2013 and 2015. Yet, in 2015 notifications by doctors in the private sector comprised only 16 per cent of the total. Though notification was made mandatory in 2012, only 1.7 million incident TB cases in the public and private sectors were notified in 2015. Thus the fate of 1.1 million patients is simply not known: they have fallen off the radar. For an effective fight against TB, the control programme needs to be aware of every single patient diagnosed, and offer treatment to all. If there are only about 50 per cent of the patients approaching the private sector who successfully complete treatment, a recent study has shown that in 2013 only about 65 per cent of the 1.9 million who approached the public sector completed the treatment regime. The crisis has been aggravated with the disease becoming more expensive and difficult to treat and the number of people with drug-resistant forms increasing. The national TB control programme is behind schedule with respect to critical programmes including the expansion of the GeneXpert pilot programme, scaling up of drug sensitivity testing, and the introduction of a child-friendly paediatric TB drug. Only sustained action on several fronts can help bring TB under check. The global war will not be successful till India wins the battle within its own boundaries first.