A new edge to the fight against tuberculosis (GS Paper 2, Health)
Context:
- At the One World TB Summit in Varanasi, Uttar Pradesh on March 24, 2023, Prime Minister instilled fresh energy to the global tuberculosis (TB) elimination response and reiterated India’s commitment to spearhead this effort.
- He further emphasised the importance of innovation and the need to “find new ways and formulate new strategies” to achieve the desired outcomes.
India’s efforts to eliminate TB:
- Over the last few years, India has made significant progress in its efforts to end TB.
- India’s National TB Elimination Programme, or the NTEP (previously known as the Revised National Tuberculosis Control Programme, or RNTCP), has introduced several measures to find, notify and treat TB cases, with case notifications rising from 15.6 lakh in 2014 to over 24 lakh in 2022. This reflects the programme’s expanded reach and improved detection measures.
- Further, novel approaches including engagement with the private sector, launch of social support provisions and introduction of diagnostic tools and new drug regimens, have improved TB management.
Challenges:
- The lack of widespread awareness about the disease and lack of access to quality care continue to be a challenge.
- The recent National TB Prevalence Survey (in India) found that 64% of people with infectious TB did not seek care. As a result, national-level estimates suggest that for every person notified with TB, we miss detecting almost two more cases.
Disruptive approaches:
- To address this challenge and truly bring transformative change TB response efforts, there is need to introduce disruptive approaches and new tools to change the way to prevent, diagnose, and treat TB. India has long recognised the importance of investing in health research and development, especially in recent years.
- The Mission COVID Suraksha programme to develop vaccines was a good example of a public-private partnership, with clear goals and outcomes. The huge number of diagnostic tests developed and a variety of different vaccine platforms show that manufacturing sector is robust and can scale rapidly.
- The establishment of centres of excellence will facilitate collaboration between Indian Council of Medical Research laboratories and the private sector.
- It is possible, therefore, to strengthen and expand research and development efforts for TB, to develop new tools that will help India (and other developing countries) meet the End TB targets.
Future Roadmap:
Prioritise TB vaccine trials:
- For any infectious disease, a vaccine is what makes elimination possible. The Bacille Calmette-Guérin (BCG) vaccine for TB does not adequately protect adolescents and adults who are at the highest risk for developing and spreading TB.
- There are currently over 15 TB vaccine candidates in the pipeline; it is must to ensure that their clinical trials are prioritised to assess their efficacy in various community settings and for different target groups.
Diagnosing:
- Testing for, and diagnosing TB needs to become more accessible and affordable so much so that each person with suggestive symptoms or frontline worker can test and get results within minutes, at minimal costs.
- Point-of-Care Tests (POCTs), such as home-based tests for COVID, allowed decentralised, rapid and low-cost diagnostics to provide results within minutes. New innovations such as nasal and tongue swab-based tests for TB can be a game changer by reducing diagnostic delays.
- Further, handheld digital x-ray machines (with artificial intelligence-based software) can now be taken to villages and urban settlements to screen large numbers of high risk individuals, safely and conveniently.
New therapeutic molecules:
- The development and introduction of new therapeutic molecules can play a crucial role in the long run.
- Shorter, safer, and more effective regimens do exist and include the 1HP regimen for latent TB infections, the four-month regimen (HPZM) for drug-susceptible TB, and the six-month regimen (BPaL/M) for drug-resistant TB.
- The evidence on these regimens is clear; timelines for scale-up, however, have been too long.
Appropriate policy frameworks:
- A part of the process of strengthening the innovation ecosystem also involves creating regulatory and policy frameworks that smoothen the rollout of proven tools to reach people with as little delay as possible.
- This requires greater collaboration: not just between policymakers, scientists, product developers and clinical researchers across the country and even across regions, but potentially even between governments.
- Harmonisation of standards and regulatory processes between countries can enable mutual recognition of evidence-based standards and licences and save critical time towards rollout.
Way Forward:
- With its G-20 presidency, India has another historical opportunity to build a global health architecture that creates equitable access for all.
- TB should no longer be the leading infectious disease killer globally, in the 21st century, and India can lead the way.
