[Editorial Analysis] Pandemic is an opportunity to re-imagine TB care

Mains Paper 2: Health
Prelims level: World TB day
Mains level: Government Policies and Interventions

Context:

• A novel virus SARS-CoV-2, which had only just been described, overtook an ancient bacteria, tuberculosis or TB, as the leading infectious cause of death.
• Mortality from COVID-19 exceeded the daily toll of 5,000 deaths from TB. Suddenly the 10 million or so deaths annually from TB paled into insignificance when compared to the 85 million annual mortality from COVID-19.

World TB day:

• World TB Day is observed on 24 March each year to raise awareness and understanding about one of the world’s top infectious killers and catalyze action to address its devastating health, social, and economic impact around the world.
• March 24 marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.
• The theme of World TB Day 2021 – ‘The Clock is Ticking’ –conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders.
• This is especially critical in the context of the COVID-19 pandemic that has put End TB progress at risk, and to ensure equitable access to prevention and care in line with WHO’s drive towards achieving Universal Health Coverage.

Statistics:

• Provisional data compiled by the World Health Organization (WHO) from 84 countries indicates that an estimated 1.4 million fewer people received care for tuberculosis (TB) in 2020 than in 2019 – a reduction of 21% from 2019.
• In the group of 10 high-burden countries with the largest reported shortfalls compared with 2019, the overall shortfall was 28%. With many people with TB unable to access care, WHO estimates that half a million more people may have died from TB in 2020 alone.
• TB remains one of the world’s top infectious killers.

Looming impact and synergies of these two airborne diseases:

• One as old as human civilisation, and the other unknown till a year ago. It is now clear that patients with TB are more prone to COVID and if they do contract the disease their need for hospitalisation and ICU is higher, so is the mortality rate of such patients, whose lungs are already weak.
• The huge TB patient population of India is thus a vulnerable one, and if patients with latent TB are also at higher risk from TB, as some experts feel they are, then the alarm should be ringing as 40 per cent of all Indians are believed to be latently infected.
• These airborne diseases affect the same population. Perhaps it is no coincidence that diabetes, overcrowding, poverty and air pollution are amongst the most common bio-social determinants of not just TB, but also COVID-19.
• It is projected that the COVID pandemic has already pushed an additional 100 million below the poverty line: A population which will then be more vulnerable to the ravages of TB as well.

Problems faced by TB Patients:

• TB is a disease that is very unforgiving of irregularities in follow up or treatment and we are only now seeing large rebounds in the numbers of patients, many of whom have developed drug resistant (MDR or XDR) TB due to irregular visits to DOTS centres. This applies to private clinics as well.
• The world’s largest and longest lockdown spelt misery for this country’s huge TB population. Suddenly patients found it impossible to access TB services and large numbers of them dropped off the radar. TB notifications declined dramatically which means these patients “disappeared” without access to diagnosis or treatment for the many months of the lockdown.
• The path to successful TB diagnosis and cure is a long and winding road at the best of times, with nine months to two years of uninterrupted treatment being the norm.
• The hurdles posed by COVID proved insurmountable and sadly many patients gave up the race. Scared to leave their houses, lacking the transport to reach TB centres, the woes of these patients multiplied with drug stock-outs and shortages of TB.
• Economic and nutrition packages that had been promised to poorer TB patients also took a hit as did services for the HIV-affected. All these directly and indirectly added another level of complexity to the suffering of our Indian TB patients.
• Sadly, the collateral damage from COVID on TB is long lasting and runs deep. It threatens to set back by many years the fragile recent gains made by India’s National TB programme (NTP).

Way ahead:

• This crisis is, therefore, also an opportunity to reimagine TB care. To reinvest in our underfunded and overburdened paradigms of TB care, which are already beginning to look dated and uninspired.
• Investing and fast-tracking the TB drug and vaccine pipeline is a need of an hour. It is scandalous that TB has a single vaccine which is a century old whilst 12 COVID vaccines, discovered at breath-taking scientific speed, are already in deployment across the globe with over 70 in Phase 3 trials and 175 in pre clinical stages.
• Ensure effective infection prevention and control measures, to protect the health and safety of health workers, staff, and patients.
• Scale up simultaneous testing for TB and COVID-19, taking into consideration similarity of symptoms (cough, fever and difficulty breathing), and based on exposure or presence of risk factors.
• Promote access to people-centered prevention and care services.
• Stand against stigma and discrimination and promote the human rights of the most vulnerable.
• Build and strengthen community, youth and civil society engagement to close gaps in care.

Conclusion:

• Every crisis it is said, is an opportunity in disguise, and telemedicine helped us reach out to our most difficult XDR-TB patients.
• Masks have become the new norm, and our TB patients are thus less destigmatised and less likely to transmit infection in crowded communities.

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Prelims Questions:

Q.1) With reference to the Jammu and Kashmir, consider the following statements:

1. The High Court of Jammu and Kashmir will be the common High Court for the Union Territories of Ladakh, and Jammu and Kashmir.

2. The expenditure in respect of salaries and allowances of the Judges of the common High Court shall be allocated amongst the Union territory of Jammu and Kashmir and Union territory of Ladakh on the basis of population ratio.

Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2
Answer: C

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