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[op-ed snap] Reaching the unreached: Tuberculosis

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Read the attached stories for the particulars of the TB disease

Mains level: The newscard discusses the issue of non-reporting of TB cases and government steps against it.


News

Government action against non-reporting of TB cases

  1. The government has recently passed a gazette notification making the non-reporting of TB cases a punishable offence, with even a jail term of up to two years
  2. The move comes against the backdrop of the Prime Minister’s call to end TB in India by 2025, ushering in a ‘mission mode’ approach to defeat the disease

Non-reporting of TB cases in India

  1. A study in The Lancet in 2016 estimated that as many as 22 lakh cases of TB were treated in the private sector in 2014; in the public sector, the figure was 14 lakh
  2. Going by The Lancet ’s estimates, almost 19 lakh cases are still ‘missing’

What is the harm if a patient is not reported to the government and is being diagnosed and treated in the private sector? 

  1. First, not being reported to the government means the true burden of the disease remains unknown
  2. Second, the absence of drug distribution controls and poor treatment practices accentuate the emergence of drug-resistant TB
  3. Anti-TB drugs are widely available without prescription at numerous pharmacy outlets
  4. Also, limited usage of the Standards for TB Care in India (STCI), which are the standard protocols to be adhered by providers, leads to incorrect diagnosis and improper treatment
  5. This in turn delays the commencement of treatment and can even contribute to drug resistance
  6. Finally, TB is five times more common among the economically weaker sections of society and the disease can have devastating financial and social consequences

Steps taken by the government

  1. In order to address these issues, the government has proposed innovative measures which include a ‘direct benefit transfer’ for nutritional support and free diagnosis and treatment
    (particularly to patients being treated in the private sector)
  2. However, the first step in extending these support systems to all patients would be to correctly identify them

‘Nikshay’ 

  1. A web-based application called ‘Nikshay’ was launched in 2012 to help providers notify cases to the authorities
  2. However, low awareness about this portal among private providers and technical difficulties in the software resulted in its low use
  3. Considering that punitive action can be taken against providers for not reporting cases

The way forward

  1. The notification policy, supplemented by
    (1) the comprehensive strengthening of the public health system,
    (2) greater engagement with the private sector,
    (3) the simplification of the reporting process and more awareness among public and health-care providers,
  2. is sure to reach the goal of a TB-free India

A quarter of TB patients are resistance to anti-tuberculosis drugs, says survey

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Prelims level: Nikshay Aushadi Portal, Global TB Report 2017, etc.

Mains level: Findings of the national anti TB drug resistant survey report


News

The national anti TB drug resistant survey report 

  1. The survey was done between 2014 and 2016 by ministry of health and family welfare
  2. According to the report, more than a quarter of Tuberculosis (TB) patients in India have drug resistance to one or the other anti-TB drug
  3. The health ministry has claimed that this is the largest ever national drug resistance survey conducted by any country in the world
  4. And the first ever survey having Drug Susceptibility Testing (DST) for 13 anti-TB drugs using the automated liquid culture system, mycobacteria (causing TB) growth indicator tube (MGIT) 960®

Other findings of the report

  1. The results of the survey released on the World TB day showed that MDR-TB is 6.19% among all TB patients with 2.84% among new and 11.60% among previously treated TB patients
  2. Around 54% patients resistant to these drugs do not successfully complete treatment and death rates stand at 20%

The Nikshay Aushadi Portal 

  1. The Union health ministry has recently launched the Nikshay Aushadi Portal and shorter regimen for Drug Resistant TB

The Global TB Report 2017

  1. It was published by World Health Organization (WHO)
  2. It estimates that India contributes 27% (2.79 million) and 25% (147 000) of the global burden of TB and MDR-TB, respectively

[op-ed snap] The long fight against TB

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Revised National TB Control Programme

Mains level: Drug resistance and TB


Context

Rising incidence of TB in India

  1. The incidence rate of tuberculosis (TB) in India is estimated at 200-300 cases per 100,000 population per year
  2. As a comparison, in western Europe, it is five per 100,000 per year
  3. India’s estimated annual TB burden is 28 lakh, 27% of the global total
  4. Every day 1,200 Indians die of TB — 10 every three minutes
  5. Revised National TB Control Programme (RNTCP) has become a great humanitarian programme of free diagnosis and treatment instead of a control programme

Identification of TB

  1. Infection with TB bacilli is the necessary cause of TB
  2. Cough and blood in sputum occur only in lung TB
  3. Pelvic TB is the commonest cause of female infertility in India
  4. TB can affect the lungs, brain, bones, joints, the liver, intestines or for that matter any organ and can progress slowly or kill in weeks

Designing TB control

In designing TB control three processes must be understood: infection, progression, transmission

  1.  Infection occurs when TB bacilli are inhaled
  2. Progression occurs when bacilli become active, multiply and cause pathology
  3. Only when active TB affects the lungs do bacilli find an exit route to the atmosphere, necessary for transmission

Principles of control

  1. Beginning with schools, public education on TB and its prevention must replace ignorance and misconceptions
  2. No one should spit in public places and also practice cough and sneeze etiquette (covering one’s mouth and nose when coughing or sneezing)
  3. To block transmission, treatment should begin as soon as a symptom shows up

Way forward

  1. To outsmart TB bacilli, we must intercept infection, progression, and transmission
  2. Our only chance of victory is by the concerted use of all interventions — biomedical and socio-behavioral
  3. Any further delay may convert a controllable disease into an uncontrollable one, because of increasing frequency of resistance to drugs against TB

PM launches campaign to eradicate TB by 2025

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: TB Free India Campaign, Delhi End TB Summit

Mains level: Rise in cases of Tuberculosis and measures to eliminate it


News

Advancing deadline for TB elimination

  1. India’s TB elimination goal was advanced by five years ahead of the global target of TB elimination
  2. While the global deadline for ending TB is 2030, PM Modi has expressed confidence that India will achieve its target by the year 2025
  3. The Prime Minister also launched the TB Free India Campaign at the Delhi End TB Summit

Delhi End TB Summit

  1. The Delhi End TB Summit is being organized by the Government of India, the Stop TB Partnership, and World Health Organization (WHO) Regional Office for South-East Asia (WHO-SEARO)
  2. The Summit will continue the high-level dialogue that was started in Moscow last year during the Global Ministerial Conference to End TB
  3. It will set the stage for the September 2018 United Nations High-Level Meeting (HLM) on TB, where Heads of State are expected to commit to an ambitious plan of action to put the world on track to ending TB

WHO launches plan for cheaper TB drugs

Note4students

Mains Paper 3: Science & Technology | Science and Technology- developments and their applications and effects in everyday life Achievements of Indians in science & technology; indigenization of technology and developing new technology

From UPSC perspective, the following things are important:

Prelims level: EoI, TB drugs, etc.

Mains level: The decision will help in making low cost TB medicines.


News

Invitation for Pharmaceutical Companies

  1. The WHO has invited pharmaceutical companies around the world to submit proposals to manufacture affordable versions of newer medicines for treatment of drug resistant tuberculosis
  2. WHO has now requested drug makers to submit an Expression of Interest (EoI) for Bedaquiline and Delaminid, two new-generation drugs, recommended for drug resistant-TB
  3. Under WHO norms, drugs submitted upon such requests and complying with its standards are included in a list for procurement by the UN and other organisations

What is the aim behind this invitation?

  1. The aim is to replicate the success of addressing the HIV epidemic
  2. For example, competition among Indian drug producers had then brought down the price of HIV medicines by 99% from $15,000 per patient per year to less than a dollar a day
  3. Also, one of the aims of is to ensure that a greater number of manufacturers are supplying quality medicines, which, in turn, means a more competitive market and more affordable prices

India’s condition

  1. India has nearly 1.3 lakh DR-TB patients, the most in the world, but the Health Ministry gets only 10,000 doses of Bedaquiline and 400 doses of Delaminid
  2. The medicines are obtained as donations from Janssen (US) and Otsuka Pharmaceuticals (Japan), the respective manufacturers

[op-ed snap] Incentivizing new vaccine development

Image Source

Note4students

Mains Paper 3: Science & Technology | Science and Technology- developments and their applications and effects in everyday life Achievements of Indians in science & technology; indigenization of technology and developing new technology

From UPSC perspective, the following things are important:

Prelims level: Particulars of the TB disease, Click2read

Mains level: Issues discussed in the article, regarding the development of an effective vaccine


News

Tuberculosis (TB) is one of India’s severest health crises

  1. It kills two Indians every 3 minutes and more than 1,000 people every day
  2. India accounts for 27% of the world’s 10.4 million new TB cases, and 29% of the 1.8 million TB deaths globally
  3. Surely, this says something about the crisis in our public health policy
  4. And receltly, WHO’s deputy governor was saying that India doesn’t have a good TB vaccine

Issues with the current vaccine

  1. TB is difficult to diagnose, and the BCG vaccine that is currently in use (developed in the early 20th century) is ineffective for young people and adults
  2. A new vaccine, cheaper and effective diagnostic tests, and treatment for the drug-resistant strains of TB are needed

Why should government focus on vaccine development?(for TB)

  1. The government should have focused more on creating a vaccine
  2. They are easy to administer, need little diagnosis before use and can be taken in a few doses rather than involving long treatments

Lack of progress in developing a vaccine for TB

  1. It is part of a larger problem
  2. There is a dearth of overall R&D on diseases concentrated in poor countries

Reasons behind the lack of private investment in the area(in countries like India)

  1. One reason for the lack of private investment is that the potential consumers (patients and governments) are poor
  2. But there are two other reasons:
    FIRST
  3. The benefits of the research on these diseases spill over to many countries, so none of the small countries has an incentive to unilaterally support the research
    SECOND
  4. Governments have a poor record of respecting patents
  5. WHO’s The Agreement on TRIPS has provisions for ‘compulsory licensing’ that allow governments to license the production of essential drugs to local manufacturers who must then pay royalties to the innovator
  6. The problem, therefore, is that the medical innovation industry doesn’t consider poor countries as their market

Government’s goal of eradicating TB

  1. Government has announced the goal to eliminate TB by 2025
    National Strategic Plan (NSP) for TB Elimination
  2. The main features of the proposed National Strategic Plan (NSP) for TB Elimination, 2017-2025 are providing (i) incentives to private hospitals to follow standard protocols for diagnosis and treatment,
    (ii) giving cash transfers to patients to compensate them for the direct and indirect costs of undergoing treatment as well as incentives to complete treatment
  3. This is in addition to free diagnostics and treatment for TB at government hospitals
  4. Given the fact that incomplete treatment and improper care leads to the development of drug-resistant TB, these interventions are welcome

The way forward

  1. The government must take steps to encourage research, both basic and applied
  2. It could make budgetary accommodation, or use its position in global diplomacy to encourage other nations and donors to do so
  3. Ultimately, it will have to appeal to the interest of private companies for medical innovations

‘Miracle’ TB drug hit by low enrolment

  1. Six months after the launch of ‘miracle’ drug bedaquiline, the Govt has enrolled a mere 36 patients
  2. Other countries like South Africa, Swaziland or even Belarus have put nearly 5% of their MDR TB patients on bedaquiline within a year

India sets an example in subsidised TB diagnosis

A study, published recently in the journal Lancet Global Health, has indicated that India is the best country in the world to offer subsidized TB diagnosis.

  1. Of the 12 high-burden countries where the private sector is a major player in providing health care.
  2. The Indian private sector offers the cheapest price for the WHO-approved Xpert MTB/RIF, a molecular test for diagnosing TB.
  3. Access to accurate tests at subsidised price is very important in India as nearly 80% of the population in India first seek the private sector.
  4. If one out of every four TB patients in the world is an Indian, one in eight TB patients in the world is a privately treated Indian patient.
  5. Hence, to further reduce the costs, the study asks the Indian government to waive off customs duty of 31% levied on Xpert machine and reagents.

Child-friendly TB drugs launched

  1. Child-friendly TB drugs for first-line medication in a fixed-dose combination were launched for the first time.
  2. The availability of child-friendly TB drugs of correct dosages will increase drug adherence and thereby reduce acquired drug resistance.
  3. Earlier,  the adult drugs had to be crushed  to achieve an appropriate dose for a child making it all the more difficult to administer to young children.
  4. Since the fixed-dose combinations come in a dissolvable form, tablets no longer need to be crushed.

Chennai’s new strategy to eliminate TB

To help communities move to zero deaths from tuberculosis in their own way, and create “islands of elimination”, which will reverse the overall tuberculosis epidemic.

  1. With this project, Chennai may drastically reduce TB mortality, shrink the number of new cases annually and impact TB prevalence in the city in a matter of 3-5 years.
  2. The Zero TB Cities project earnestly embraced the Zero TB Declaration in 2012, that calls for a “new global attitude” in the fight against TB.
  3. The project envisages a comprehensive tuberculosis elimination strategy at the community level by using all the currently available arsenals.
  4. The “island of elimination” strategy does not call for any breakthroughs but requires a change of mindset.

Chennai has been chosen as one of two cities in the world where the Zero TB Cities project will try to create an “island of elimination”. Lima in Peru is the other city.

TB ranks alongside HIV as leading killer worldwide: WHO report

Ending the TB epidemic is part of the Sustainable Development Goal agenda.

  1. In 2014, tuberculosis (TB) killed 1.5 million people, 400,000 of whom were HIV-positive.
  2. Fight against TB is paying off, however, with this year’s death rate nearly half of what it was in 1990.
  3. WHO’s Global Tuberculosis Report 2015, most of the improvement came since 2000, the year the Millennium Development Goals (MDG) established.
  4. Need to close detection and treatment gaps, fill funding shortfalls, and develop new diagnostics, drugs and vaccines.

Fund crunch hampers TB fight

  1. Government has failed to meet annual targets to control spread of the nation’s most fatal infectious illness.
  2. India records more than 300,000 TB related deaths and 2.2 million new cases of TB each year.
  3. The draft report is not in the public domain but was leaked on the Internet by health activists

Hi-tech facility that detects TB in two hours

  1. Mysuru to get a state-of-the-art facility under the Revised National Tuberculosis Control Programme (RNTCP).
  2. The cartridge-based Nucleic Acid Amplification Testing (CBNAAT) equipment.
  3. Support from the World Health Organisation (WHO), National AIDS Control Organisation (NACO) & USAID.
  4. Once TB is detected, the patient is supposed to take meds under the Directly Observed Treatment (DOT), recommended by WHO.

Not everyone with TB infection may suffer from the disease: IMA

  1. As such human immune system can stop the contagious TB bacteria from multiplying.
  2. Such people are called “TB infected” but, they don’t feel sick or show symptoms or spread TB.
  3. But if person suffering HIV, diabetes mellitus, malnutrition, then it can’t fight against TB infection.
  4. Such people are called “TB diseased patients”, each of them capable of infecting 10 more.

IMA says – Patients with TB should be tested for HIV

  1. If a person has HIV and TB co-infection it means that they have both HIV infection and either latent TB or active TB disease.
  2. HIV infection and infection with TB bacteria are though completely different infections.
  3. But people living with HIV are at greater risk of developing TB owing to the weakened immunity.
  4. Progression to TB disease is often rapid among people infected with HIV and can be deadly.

Indian Medical Association on TB & Swine Flu

  1. Swine flu is a droplet infection, while TB is droplet nuclei infection. What’s that?
  2. Droplet infection = Infected particles of size > 5 microns & Droplet nuclei infection = < 5 microns.
  3. This essentially makes TB more easily transmittable – hospital can be a place where TB is transmitted to other patients and healthcare staff.
  4. While prevention of flu requires simple three layered mask, the one for TB prevention requires N95 mask.

    Discuss: An estimate – In India, 2.1 MM new TB cases occur annually and 2,40,000 TB deaths occur every year. The article speaks about an ethical liability with the patient to disclose his/ her illness



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