In numbers: India’s continuing TB battle

Kruxd 22

Nearly a third of the world’s Tuberculosis cases occur in India. Notwithstanding the impact of COVID and financial challenges, the country remains committed to eliminating the disease by 2025

March 24 is commemorated as World TB Day every year, to raise public awareness about the devastating health, social and economic consequences of the disease and to step up efforts to end the global TB epidemic.

This World TB Day, Kruxd does some number-crunching about India – the country with the heaviest TB burden in the world –  to track its battle with the contagion over the last few years.

Have we missed millions of cases?

India’s official TB platform – Nikshay – logs annual, state-wise data on case notifications in the country. Numbers show that actual notifications have consistently fallen short of targets – missing 1,187,350 cases in 2020 alone. In four out of the last five years, the shortfall was in excess of 25 percent – 2020’s being nearly 40 per cent.

How much does the country spend on TB care?

As the country with the world’s highest TB burden, India’s efforts against this disease are reflected in its budget allocations. Official budget data for the country’s TB programme highlights the fact that the approved budget has been markedly less than the requested amount.  In 2015-16, for example, ₹6.4 billion were approved, against the requested amount of ₹13 billion – a deficit in excess of 50 per cent. Between 2015-16 and 2020-21, the gap between requested and approved budgets has widened to ₹30 billion.

So where do we stand?

The year 2020 was the first time in over a decade that TB deaths increased. A Health Analytics Asia report in March 2021 assessed the severity of COVID’s impact on TB care in India. The estimated additional burden due to the setback of just the first wave in India was 1.8 million cases and more than half a million deaths between 2020 and 2025. Factor in the deadly second and third waves that followed, these numbers may well swell up further. And this is in addition to the cases missed by drop in notifications – nearly 4 million in five years. Resumption of pre-pandemic levels of TB care, therefore, will not suffice, making additional measures imperative.

The 2022 World TB Day brings focus on investments in healthcare, diagnostics, treatments and associated infrastructure. The theme set by WHO – “Invest to End TB. Save Lives.” – conveys “the urgent need to invest resources to ramp up the fight against TB”. WHO also notes that the global spending on TB in 2020 was “less than half of the global target of $13 billion annually by 2022.”

The Stop TB Partnership, administered by the UNOPS, while also recognising the impact of recent armed conflicts, calls for quadrupling of funding available in the global fight against TB, noting that the “world is failing the TB response.”

With just about three years left in India’s 2025 TB elimination goals, all eyes are on whether the country’s frailing health infrastructure can rise from the proverbial ashes and get somewhere close to the goal, if not achieve it.