KATHMANDU, Nepal - The country with the world’s highest tuberculosis burden has launched an ambitious plan to eradicate the deadly disease by 2025, five years ahead of the global target.
Speaking at the summit in the Indian capital on Tuesday, Prime Minister Narendra Modi launched the TB-free India Campaign.
“A target has been set to end TB globally by 2030. I would like to announce that we have set an aim to eradicate it from India five years ahead by 2025,” Modi told the audience.
The campaign puts the country’s strategy to end TB announced last year into effect.
India’s National Strategic Plan 2017-2025 as part of the Revised National Control Programme aims to rapidly scale up the number of people who are tested and successfully treated for TB, with a focus on active case finding.
To do so, health workers will target vulnerable groups over the next four years including slum and prison communities, hard-to-reach rural areas and populations known to have high rates of malnutrition.
Emphasis will also be placed on strengthening the private sector, where more than half of TB patients seek care.
To improve care in the private sector which is usually hampered by diagnostic delays and poor treatment, and to deter doctors from sending patients to the overwhelmed public sector, the strategy includes free drugs and diagnostic tests for all patients. Incentives will also be given to private providers who ensure treatment adherence and completion and who notify the government of positive cases.
The government also provides all patients with 500 Indian rupees ($7.50) per month for nutrition support for the duration of treatment.
Every year, more than 10 million people contract TB and India accounts for more than one-fourth of cases, according to the WHO’s 2017 Global TB report. Not only does India have the highest burden of TB, but it also has the highest number of multidrug-resistant, or MDR-TB, cases worldwide.
TB killed 1.7 million people in 2016, including more than 400,000 people in India.
A realistic goal?
While those in attendance applauded the announcement, some in the health community greeted the 2025 goal with skepticism, calling the timeline impossible and one that ignores harsh on-the-ground realities.
“The least they could have done is spoken to people who are on the receiving end of the system to know what is going on.”— Nandita Venkastesan, a TB survivor and patient activist
“Eliminating TB by 2025 is next to impossible. Anyone even fairly aware of ground realities will know this is not possible,” Nandita Venkastesan, a TB survivor and patient activist from Mumbai, told Devex.
“I would rather set realistic targets and acknowledge the scale of the problem.”
Madhu Pai, global TB expert and director of McGill University Global Health Programs in Montreal, agreed the target was unrealistic. He told Devex the key issue was not “ambition or political commitment” but rather funding and accountability to ensure India executes its promises in an efficient and timely manner.
Venkastesan, who is attending the summit, said she was angered by the gullibility of TB leaders attending; that no one had questioned India’s targets.
“This near uncritical assessment of things is a letdown for a survivor,” she said.
“The least they could have done is spoken to people who are on the receiving end of the system to know what is going on.”
However, Dr Lucica Ditiu, executive director of the Stop TB Partnership, disagreed. She believes India has the political will and finances to end the disease by 2025.
“I’m concerned that rather than trying to push other countries for the same type of leadership we’re shooting ourselves in the foot,” she said.
“We have one country, the biggest country, committing to ending TB and now we start being concerned and start questioning that.”
She admitted that reaching the goal would require change in India that would “ruffle feathers” but stressed no other heads of state had launched similarly ambitious goals.
“The government wants to see a change and politicians want to show some achievements,” she said.
Civil society demands
Meanwhile, survivors of MDR-TB, health organizations, and the TB community in India and across the globe have appealed to Prime Minister Modi to issue compulsory licenses for two essential drugs to fight the disease.
To this day, the origins of one of the world's oldest disease — tuberculosis — is still being debated. But the more pertinent question is where is it going?
In a letter to Modi, 60 civil society organizations asked the government to urgently issue licenses for bedaquiline and delamanid — the two newest drugs used to treat MDR-TB, the first in half a century.
The two drugs are on the WHO’s Essential Medicines List for the disease.
However, they are all but out of reach for India’s 147,000 drug-resistant patients because they are under patent by their manufacturers and are prohibitively expensive. India currently relies on small donations of the drugs by their two manufacturers. According to local media reports, only 1,000 Indian patients have been able to access the life-saving drugs.
“We are in desperate need for better drugs. Present drugs have rotten side effects that destroyed lives like mine,” Venkastesan, who lost 90 percent of her hearing during treatment, a side effect of harsh older drugs, said.
Under the Patents Act, the government can issue a compulsory license for a pharmaceutical company for public noncommercial use of their drugs in cases of extreme urgency and national emergency.
A compulsory license for the two TB drugs would encourage generic production, create competition, drive down prices, and provide impetus to the scaling up of the new drugs globally, the letter argued.
“India’s role is thus critical and it needs to desist from endorsing secretive bilateral, voluntary licensing deals between pharmaceutical companies for their own profits, and instead, operationalise generic supply through a government use licence,” the letter read.
United Nations meeting
Tuberculosis experts and advocates are setting ambitious goals for the first U.N. high-level meeting on the disease, to be held next year.
The summit this week has set the stage for the September United Nations High-Level Meeting on TB, the first meeting on the disease.
Global TB experts hope the meeting will endorse additional targets for 2020 and 2025 as well as an accountability mechanism and numerical funding goals.
The Sustainable Development Goals aim to end the TB epidemic by 2030.
*Update, March. 16, 2018: This article has been updated to clarify that Nandita Venkastesan is a survivor of TB.