Message from Dr. Soumya Swaminathan
TB is both a social and a scientific challenge. Enough people mistakenly believe that TB is a disease of the past. The fact remains that if we look closer, we will find that people suffering from TB are part of our personal, professional and social networks. It is a scenario, where at least in India, very few are left untouched or unaffected.
About one-third of the world's population and about half of the Indian adult population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease. TB is spread via aerosol infection – the bacilli enter the body through the lungs, usually establishing a pulmonary infection which can flare up much later when the conditions are right. If left untreated, a person with active disease can infect up to 15 people simply by coughing or sneezing. BCG vaccine provides protection against severe TB disease in infants, but it is ineffective against adolescent and adult pulmonary TB. Persons with weakened immune systems, such as people living with HIV, those on dialysis or cancer treatment, or people with malnutrition or diabetes or who use tobacco have a much higher risk of becoming sick with active TB disease. Only 1 in 10 people who are infected will develop TB disease in their lifetime, but this risk is much higher at extremes of age and when the immune system is weak.
TB remains one of India’s severest health crises and a key public health challenge. The country accounts for 18% of the world’s population and 27% of the global TB burden. India accounts for 2.8 million of the 10.4 million new TB cases globally, according to the WHO Global TB Report 2016, which revised and raised its global estimates in 2016 after improved surveillance data from India registered a spike in new cases; the mortality stood in 2015 at 480,000. And this, despite the fact, that the government provides free diagnosis and treatment services to patients. Approximately 9 million persons were screened for TB and 1.4 million patients were put on treatment by the government in 2015.
The problem is further exacerbated by the emergence of drug-resistant forms of the disease. India is estimated to have the highest number of DRTB and second highest number of HIV co-infected TB patients. Growing drug resistance is slowing cure rates – MDR-TB treatment success rate globally, was an abysmal 52% in 2013. About 2.5% of all new TB cases in India are resistant to rifampicin, or to both rifampicin and isoniazid – the two most commonly used anti-TB drugs. At the end of 2015, India had 79,000 cases of drug-resistant TB, 11% more than in 2014. According to some estimates, 40% of the adult population in India has latent TB with a 10% life-time risk of developing TB. So, latent TB must also be addressed to prevent new active cases, else, incidence will continue to increase.
Challenging numbers to say the least. The human tragedy overwhelming.
TB incidence is declining by about 1-2% per year. However, to achieve the SDGs and END-TB strategy targets by 2025, we need to have a decline in TB incidence by about 15-20% per year. Towards this goal, some immediate priorities are:
There is strong commitment from the Government of India to tackle TB head-on as has been declared in the Union Budget 2017-18 with a well-defined national strategic plan to eliminate TB.
In order to ramp up India’s response to TB elimination, the India TB Research Consortium (ITRC) has been constituted to align all efforts in TB care and elimination, a coalition of diverse stakeholders, who through their diversity of thought and ideas will adopt and implement a fresh approach to TB elimination. The ITRC brings together diverse stakeholders to develop new tools – diagnostics, vaccines and drugs – to enable India to take a leadership role in fast-tracking translational TB research and find solutions for the world. ITRC aims to achieve this goal through adopting an interdisciplinary collaborative approach by harnessing national and international expertise to advance technology as well as product development by delivering effective diagnostics, shorter drug regimens, efficacious vaccines along with newer interventions for TB control and subsequent elimination of the disease.
In the interim, the India TB Research Consortium (ITRC) set up at the ICMR Headquarters in New Delhi continues to spearhead activities framed by Working Groups comprising subject matter experts constituted to translate R&D leads to products and interventions across key thematic areas – Therapeutics, Diagnostics, Vaccine and Implementation Research. The Consortium is currently being supported by several partner agencies and since its inception in August 2016, has made considerable progress in terms of taking forward its mandate. A detailed landscape analysis of research has been undertaken for each thematic area. The potential leads have been identified and are being taken forward. Efforts are also being made to find support and raise resources through diverse partnerships. The plan for the next 4-years is to support high priority projects that will lead to new tools in the fight against TB.
The science to treat TB needs a new approach and the support of diverse partners. And in this, we all have a role to play.
Partners bring in a diversity of thought, an eclectic mix of ideas that can change our whole approach to TB. Areas that need strengthening are private sector engagement, use of technology and m-health, patient support and incentives, strong advocacy, communication and community outreach etc.
Given India’s success in polio elimination, successful management of maternal mortality and universal immunization etc., the global community is keenly awaiting India’s response to TB elimination. Fortunately, viewing this as a collective responsibility, individuals and institutions are stepping forward to play very definitive roles in improving the lives of others – those that are disenfranchised, marginalised and vulnerable. Our partners are supporting us in diverse manner through financial commitments, research support and knowledge partnerships etc.
Throughout history, the world has come together to solve complex challenges. We must join hands once again to eliminate TB.Your support will prove vital. Join us in this endeavour.
With best regards,
Dr. Soumya Swaminathan