WHO’s 2021 Global TB Report reveals that years of efforts made to prevent and control TB have been reversed in the wake of tackling COVID-19 as tuberculosis deaths rise for the first time in more than a decade. SouthAsian countries have fared badly.
A study on the quality of tuberculosis care in urban India, led by the World Bank between 2014 and 2017, suggested that about two-thirds of India’s 2.75 million new tuberculosis patients were treated at private health facilities every year. The grim pointer to the dearth of public-funded medical care accompanied yet another revealing number: only 35 per cent of these patients were provided the correct treatment.
Nothing has improved in the three years gone past.
A majority of TB patients continue to receive wrong treatment. People are not being diagnosed timely; patients are prescribed the wrong drugs; many are dying; and new strains of drug resistant tuberculosis bacteria are playing havoc. The public health system, in disarray, or worse, in a shambles, remains the record-keeper of the dead: illustrating clearly how, with all attention diverted to COVID-19 in the past year, TB is taking a heavier toll than ever before.
But the government continues to celebrate the private sector. Former Union Health Minister, Dr Harsh Vardhan, actually put in a word of appreciation in his foreword message accompanying the India TB Report 2021. “The private sector is a critical partner in the fight against TB and has worked tremendously in provision of high-quality people-centred care,” his message reads.
In fact, the India TB Report 2021 admits that the National Tuberculosis Elimination Programme is challenged by discrepancies in human resource staffing. District level vacancies in some states are as high as 30 per cent. “The situation is worse where vacancies among different cadre of staff range from 12 per cent to 75 per cent,” it says.
Double whammy
COVID-19 dealt the next whammy. The diagnosis and treatment of life-threatening diseases like Tuberculosis, HIV AIDS, and Malaria took a backseat as global healthcare resources and intelligentsia were engaged in generating a COVID-19 response, according to the World Health Organisation’s 2021 Global TB Report.
Globally, tuberculosis deaths have risen for the first time in more than a decade. Experts have conveniently blamed this rise on the COVID-19 pandemic. WHO report does not criticise governments, particularly the government of India, for neglecting its public health care. It does not say that governments, like India’s, or Indonesia’s, or the Philippines or China’s could have done more, especially since the annual report has consistently pointed to the need to do more.
WHO’s report this year puts the onus of the record number of tuberculosis deaths of fewer people getting diagnosed or receiving TB prevention services. The number of newly diagnosed TB patients and those reported to national governments fell from 7.1 million in 2019 to 5.8 million in 2020. The maximum number of new TB cases reported in 2020 occurred in the WHO South-East Asian Region, with over 43 per cent of the new cases.
SouthAsia home to most people living with TB
India led all countries with a 41 per cent drop in TB notification between 2019 and 2020, way ahead of Indonesia (14 per cent), the Philippines (12 per cent), and China (8 per cent).
As per the 2021 list, the highest disease burden lay mainly in 30 countries that accounted for over 86 per cent cases. South-Asian countries like India, Bangladesh, Pakistan and Nepal are among the top 20 in terms of the absolute number of incidents. With an average decline of 23 per cent in TB case finding and enrollment in treatment, Nepal has also entered the list of the worst-hit countries.
Besides a dip in diagnostics, hindrance in access to facilities due to lockdowns and reallocation of financial and human resources to cope with the aftermath of COVID-19 and vaccinations, are also responsible for the burgeoning cases.
It could get worse
WHO’s Global TB Programme has monitored the impact of the pandemic on TB services and provided guidance and support since the declaration of COVID-19 as a public health emergency of international concern.
Projections by the global health organisation suggest the count of people developing tuberculosis and dying from the disease could be much higher in 2021 and 2022. The bleak prognosis raises the curtains on what can get worse.
“This report confirms our fears that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis,” WHO Director-General, Dr Tedros Adhanom Ghebreyesus said in a press statement put out by the organisation.
