Despite an increase in the budget to tackle Tuberculosis (TB), the interim estimated number of deaths due to the infectious disease in India rose by 10 per cent, from 500,000 in 2020 to 505,000 in 2021, noted the Global TB Report 2022 released by the World Health Organisation (WHO).
In fact, most of the estimated increase in TB deaths globally was accounted for by four countries: India, Indonesia, Myanmar and the Philippines. In 2021, 82 per cent of global TB deaths among HIV-negative people occurred in the WHO African and South-East Asia regions; India alone accounted for 36 per cent of such deaths, the report found.
The national TB budget has seen a 6.9 per cent increase, from US$ 544m in 2020 to US$ 582 in 2021. This includes an increase in domestic funding from 66 per cent to 81 per cent and a decrease in international funding from 34 per cent to 19 per cent.
However, the Ministry of Health and Family Welfare said that it had communicated to WHO that the Ministry has already initiated domestic studies to arrive at a more accurate estimate of incidence and mortality rates systematically and India’s data will be provided after the conclusion of studies in early 2023.
“The WHO has also acknowledged the Health Ministry’s position on this and noted in the Report that “estimates of TB incidence and mortality in India for 2000–2021 are interim and subject to finalisation, in consultation with India’s Ministry of Health & Family Welfare”, said the government in a statement.
Those tested for rifampicin resistance (RR-TB) stood at 76 per cent in 2021, which is 22 per cent points decline from 76 per cent in 2020. Rifampicin is the first-line TB drug, the report said. The treatment success rate stood at 56 per cent. The report also noted that the global estimate for 2020 is 0.2 million higher than that published in 2021, following an upward revision to estimates for India for the period 2000–2020.
“The major contributors to the global increase between 2020 and 2021 were India, Indonesia and the Philippines. Three countries accounted for 42 per cent of global cases in 2021–India (26 per cent), the Russian Federation (8.5 per cent) and Pakistan (7.9 per cent),” the report said.
However, India, the report also said, is among the three countries that accounted for most of the reduction in 2020 followed by Indonesia and the Philippines (67 per cent of the global total). They made partial recoveries in 2021 but still accounted for 60 per cent of the global reduction compared with 2019. Most (90 per cent) of the global reduction in the reported number of people newly diagnosed with TB between 2019 and 2020 was accounted for by 10 countries, with the top three (India, Indonesia and the Philippines) accounting for 67 per cent. In 2021, 90 per cent of the reduction compared with 2019, the report noted.
“The report provides important new evidence and makes a strong case on the need to join forces and urgently redouble efforts to get the TB response back-on-track to reach TB targets and save lives,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme. “This will be an essential tool for countries, partners and civil society as they review progress and prepare for the 2nd UN High-Level Meeting on TB mandated for 2023.”
In 2021, India is also among the 10 countries that collectively accounted for 75 per cent of the global gap between estimated TB incidence and the reported number of people newly diagnosed with TB. The top five contributors were India, Indonesia, the Philippines, Pakistan and Nigeria (24 per cent, 13 per cent, 10 per cent, 6.6 per cent and 6.3 per cent, respectively), as per the Global TB Report 2022.
“Gaps are due to a combination of underreporting of people diagnosed with TB and under-diagnosis (owing to people with TB being unable to access health care or not being diagnosed when they do). From a global perspective, efforts to increase levels of case detection are of particular importance in these countries,” said the report.
The Union Ministry of Health and Family Welfare in India taking note of the WHO Global TB Report 2022, clarified that India has, in fact, performed far better on major metrics as compared to other countries over time. India’s TB incidence for the year 2021 is 210 per 100,000 population – compared to the baseline year of 2015 (incidence was 256 per lakh of population in India); there has been an 18 per cent decline which is 7 percentage points better than the global average of 11 per cent. These figures also place India at the 36th position in terms of incidence rates (from largest to smallest incidence numbers), the government said in a press statement.
Globally, an estimated 10.6 million contracted TB in 2021, an increase of 4.5 per cent from 2020, and 1.6 million people died from TB (including 187 000 among HIV-positive people), the report said. The burden of drug-resistant TB (DR-TB) also increased by 3 per cent between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB (RR-TB) in 2021. This is the first time in many years an increase has been reported in the number of people falling ill with TB and drug-resistant TB, it said.
