Tuberculosis Elimination Strategy

Tuberculosis Elimination Strategy

A tale of two bugsop-ed snap


From UPSC perspective, the following things are important :

Mains level : Paper2- India has shown that it has political will, technical capacity and financial resource to control the infectious diseases it need to marshal these resou.rce to eradicate TB


India needs to take TB at the same level of seriousness at which it is dealing with the Covid-19.

Contrast and between the response

  • Tuberculosis in India: Indians will still have to contend with other deadly respiratory tract infections which spread via airborne transmission. We will still have to contend with one particular bug which kills millions of us and which has been around for millennia. Tuberculosis.
    • But all comparisons between COVID-19 and TB end with the superficial observation that they are both deadly respiratory tract infections.
  • Speedy tackling of COVID-19: COVID-19 began its march through humankind barely half a year ago and, in record time, scientists have identified the virus and hundreds of millions of dollars have been allocated to controlling its spread, developing vaccines (at last count, more than a dozen candidates) and testing medication regimens for those infected.
  • Waning of the epidemic: While the virus has spread to over 100 countries, the epidemic already shows signs of waning in the Asian countries where it hit first and hardest.

Response to the TB

  • How long has the TB infected us? On the other hand, TB is as old as humanity itself, infecting us for at least 5,000 years.
    • The infecting agent, a bacterium, was identified way back in 1882, by Robert Koch, signalling one of the landmark discoveries which laid the foundation of modern medicine.
  • How was the response to TB? The subsequent response to this disease, which was infamously called the White Plague and was a leading cause of death globally at the start of the 20th century, is similar to what we see today for COVID-19, but played out over decades rather than months.
    • Measures taken: TB was made a notifiable disease, campaigns were launched to prohibit spitting and containment policies, including sequestering infected persons, were implemented.
  • The first vaccine was produced over a hundred years ago, and the first curative treatments available by the 1950s.
  • Divide between rich and poor in TB infections: TB was largely beaten in the rich world, not only because of these medical miracles but also thanks to the dramatic reduction in poverty and improvement in living standards.
    • There is compelling evidence that addressing these social determinants was even more impactful than medical interventions in the war against TB.
  • The disease of squalor: TB has always been, and this is even more true now than ever before, a disease of poverty and squalor. And no country is more affected than India.
  • Every TB statistic is grim:
    • We are home to 1 in 4 of the world’s TB patients.
    • Over 2.5 million Indians are infected.
    • In 2018, over 4,00,000 Indians died of the disease.
    • To put this in stark perspective, more people died of TB in India last week than the entire global death toll of COVID-19 to date.
    • Contrast with the response to COVID-19: Given our urgent, energetic and multifaceted response to the latter Covid-19, one is left wondering why we have failed so miserably for another bug, particularly one which has been around for so long, which has been exquisitely studied and characterised, which is preventable and treatable, and which most of the world has conquered.

Why TB has not been given such attention?

  • It is because those who suffer from TB are not likely to be boarding international flights or passing through swanky airports to attend conferences.
  • It is because TB infects people in slower tides, slow enough for industries to replace the sick with healthier recruits without endangering the bottom line.
  • It is because TB does not threaten the turbines that keep the global economy throbbing.
  • It is because TB no longer poses a threat to rich and powerful countries.
  • It is because those who have TB live on the margins and have little political influence.
  • It is because TB control requires society to address the squalid environments, which shroud the daily lives of hundreds of millions of Indians.
  • It is because TB is a medieval scourge that reminds us of our shameful failure to realise a just, humane and dignified life for all our people.


If there is one lesson from COVID-19, it is that India, and the global community, has the political will, technical capacity and financial resources to act in a committed and concerted way to control infectious diseases. It needs to marshal these assets to eradicate TB, the most pernicious and pervasive infection of all, both through addressing its social determinants and scaling up effective biomedical interventions. But, for this to happen, we will have to be as concerned about the health needs of those who travel by foot and bicycle as we do for those who board cruise ships and international flights.



Tuberculosis Elimination Strategy

TrueNatPriority 1


From UPSC perspective, the following things are important :

Prelims level : TrueNat

Mains level : Menace of TB and its elimination measures

The WHO has endorsed TrueNat, an Indian indigenous molecular diagnostic tool for tuberculosis (TB) diagnosis.


  • The TrueNat TB test is a new molecular test that can diagnosis TB in one hour as well as testing for resistance to the drug rifampicin.
  • The TrueNat MTB and MTB Plus assays also show comparable accuracy to the TB-LAMP assay as replacement tests for sputum smear microscopy.
  • The data for TrueNat MTB-Rif shows similar accuracy to WHO-approved commercial line probe assays.
  • It is developed by the Goa-based Molbio Diagnostics.
  • The company was provided with technical assistance and resources by the Foundation for Innovative New Diagnostics (FIND) to help commercialise Truenat.
  • ICMR had assessed and validated the diagnostic tool. It has high diagnostic accuracy as initial test to diagnose TB.
  • It will be used as an initial test thus replacing sputum smear microscopy.
Tuberculosis Elimination Strategy

[op-ed snap]Eradication of TB by 2025op-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2-Issues relating to development and management of social sector/ services relating to health, education, human resources.

At the End TB summit, 2018 the prime minister of India made a bold commitment to end tuberculosis by 2025-five years ahead of the global target. Which is possible to achieve if the efforts are put at the level it was done in case of polio.

The toll taken by TB

  • Despite the disease being fully curable, people still die from it.
  • TB usually affects people in their most productive years and drives families into debt.
  • It has a direct link to human suffering, discrimination and also poverty.
  • Due to its infectious spread, it directly affects our economic growth as well.
  • With resilience, sufficient investment, innovative approaches and strategies and the participation of all stakeholders, TB can be defeated.

First Step- Awareness

  • The first step is the creation of awareness and empowering of communities.
  • TB affects millions, yet very few know enough about it.
  • Multilingual, multi-stakeholder awareness effort to ensure that all Indians knows about the challenges of TB and where to seek treatment is required.
  • With the expansion of the media and evolving technology, it is possible to reach everyone with the right information.

Second Step- Access to diagnosis and treatment

  • Ensuring that every Indian get access to correct diagnosis and treatment for TB, regardless of their ability to pay for it is the second step.
  • To do so, working with the private sector is necessary as was done in the case of polio.
  • There are numerous innovative private-sector programmes and partnership schemes for TB.

Role of  Private sector

  • Recently launched programmes for doctors and labs offer the private sector various incentives.
  • Even today, about half a million TB cases go unnotified, especially those seeking care in the private sector.
  • Those cases need to be tracked and ensured that everyone in the need of treatment and care gets it.
  • Organisations like Indian Medical Association and Indian Academy of Paediatrics are working with the private sector to ensure patient-centric care as per “Standards of TB Care in India” (STCI).

Drug-resistant TB

  • A key challenge is building a forward-looking plan to address and control drug resistance.
  • Drug-resistant TB is a man-made menace that is a major roadblock in a fight against TB.
  • Every TB patient must be tested for drug resistance at the first point of care, whether in the public or private sector, to rule out any drug resistance.

Efforts by the government

  • Nikshay Poshan Yojana -in which TB patients receive Rs 500 every month while on treatment was launched.
  • Nikshay Poshan Yojana ensure that the patients have economic support and nutrition during the required period.
  • ‘TB Harega Desh Jeetega Campaign’ was launched to accelerate the efforts to end TB by 2025.
  • The campaign aims to initiate preventive and promotive health approaches.
  • By applying “multi-sectoral and community-led” approach, the government is building a national movement to end TB by 2025.
  • Resource allocation towards the TB Elimination Programme has been increased by four-fold.
  • Sincere efforts need to be made to make our health systems more accessible and reliable.
  • It also required to ensure that those seeking care trust the healthcare system and get the appropriate care for completing treatment.
  • There is a need to create more labs, point of care tests, an assured drug pipeline, access to new drugs.
  • The government should also ensure counselling and support for those affected.
  • Every patient who is diagnosed late and does not receive timely treatment continues to infect others.
  • To break this cycle, government machinery at the field level should work with communities and provide free diagnosis and treatment to every affected individual.


With all the efforts, planning and resource put in place to eradicate the menace of TB from India, it is possible to achieve the goal by 2025.

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Tuberculosis Elimination Strategy

[op-ed snap] India’s TB report must be seen in light of the country’s slide in Hunger Indexop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : TB elimination in India - links to Nutrition, Sanitation


The Annual India Tuberculosis (TB) report released by the government says that India is now home to about a quarter of the total global TB patients. The current government is committed to ending TB in India by 2025.

TB in the context of Malnutrition and Sanitation

  • Prime Minister declared that rural India was open defecation free (ODF). 
  • The Global Hunger Index 2019 put India at 102 in a list of 117 countries. India’s ranking was below Nepal, Bangladesh and Pakistan. 
  • It has been established beyond doubt that TB is more of a social disease owing to its roots to poverty, malnutrition and poor sanitary conditions.

State of TB in India

  • The TB report reveals the progress on the government’s action plan on combating TB. 
  • The highest number of TB cases – As per the report, 21.5 lakh TB cases were reported in the country in 2018. This is the highest number of TB cases registered in any country. 
  • Nikshay – The report says that with the introduction of Nikshay – the computer-based surveillance programme for TB patients, the reporting of TB cases has improved dramatically.

Barriers to TB notifications

  • The working of such a surveillance programme in an unequal country like India should be taken with a pinch of salt. 
  • In a paper published in the BMJ Open concluded that despite a national notification system — of Nikshay — other factors decide notification of patients.
  • Issues like patient confidentiality, poor knowledge of notification system, etc, prevented notification of TB patients in a hospital setting. 
  • These factors are social and without intervening at that level, it is hard to believe that notification of TB cases can reach a significant number by 2025.
  • Of the total notifications, 5.4 lakh cases were from the private sector, an increase of 40% from last year. More than 80% of healthcare is now being delivered by private health enterprises.

Issues in TB control for public health system

  • Public health – An increase in the notification of TB patients could be heartening for the government. But is not a good indicator for the public health system.
  • Hunger
    • The GHI report reminds that a hungry India cannot be free of TB.
    • Dietary deprivation is a direct indicator of inequality. Unequal societies cannot be made free of disease and infirmity.
    • BMC Pulmonary Medicine journal from Ethiopia shows that the proportion of malnutrition in TB patients was nearly 60%. 
    • Even a very distal reason for malnutrition in the community became a proximal cause for TB.
  • Open Defecation
    • TB and sanitation have a direct causal relationship. 
    • The Integrated Disease Surveillance Programme run by the National Centre for Disease Control maintains a web portal that details the outbreak of epidemics.
    • The validity of the claims of the Swachh Bharat Abhiyan (SAB) through this data shows that there was no statistically significant reduction in the occurrence of vector-borne epidemics in the country, two years after the launch of SAB.


An end to TB is not possible till we end malnutrition, poverty and poor sanitation. We need a paradigm shift in the response to TB. This should include a more sensitive approach on gender and towards the underprivileged.

Tuberculosis Elimination Strategy

[pib] ‘TB Harega Desh Jeetega’ CampaignPIB


From UPSC perspective, the following things are important :

Prelims level : ‘TB Harega Desh Jeetega’ Campaign

Mains level : Elimination of TB from India

  • Union Ministry for Health and Family Welfare has recently launched a new ‘TB Harega Desh Jeetega Campaign’.

About the campaign

  • The campaign aims to improve and expand the reach of TB care services across the country, by 2022.
  • It has three pillars – clinical approach, public health component and active community participation.
  • There are some other supporting aspects of the campaign including – patient support, private sector engagement, political and administrative commitment at all levels.
  • The government will ensure that all patients, at private or public hospitals, receive free-of-cost and high-quality TB care.
  • United Nations has marked 2030 as a global target to eliminate TB worldwide but the GoI has made 2025 as its target to eliminate tuberculosis from the country.

National TB Report 2019

  • According to the report, 21.5 lakh TB cases were reported in 2018 to the government.
  • In 2017 the number of TB cases was 18 lakhs and in 2019 it has been increased to 17% in one year.
  • Notifications from private-sector health care providers reached 5.4 lakhs, an increase of 40%, contributing to 25% of all TB notifications.
  • Under the scheme, Nikshay Poshan Yojana, a total amount of Rs. 427crore has been paid to over 26 lakhs beneficiaries through direct transfers to their bank accounts.
Tuberculosis Elimination Strategy

[op-ed snap] Taking on TB: On new anti-tuberculosis drugop-ed snap


From UPSC perspective, the following things are important :

Prelims level : MDR and XDR TB

Mains level : TB Elimination strategy


The anti-tuberculosis drug pretomanid was recently approved by the US FDA. It will be a game-changer for treating people with extensively drug-resistant TB (XDR-TB) and those not tolerating multidrug-resistant TB (MDR-TB) drugs available at present.

TB scenario

According to WHO, in 2017, there were an estimated 4.5 lakh people across the world with MDR-TB, of which India accounted for 24%, and about 37,500 with XDR-TB. 

Background of the new drug

    1. Pretomanid is only the third drug in the last 40 years to get FDA approval.
    2. Simpler regime – It is an all-oral, three-drug regimen of bedaquiline, pretomanid, and linezolid (BPaL).
    3. High success rate – It had a 90% cure rate in a phase III trial in South Africa; against the current treatment success rate for XDR-TB and MDR-TB at 34% and 55%, respectively.
    4. HIV – It was found to be safe and effective in curing TB in people living with HIV. 
    5. Shorter duration – Unlike 18-24 months needed to treat highly-resistant TB using nearly 20 drugs, the BPaL regimen took just six months.
    6. Effective and better tolerated – It was better tolerated and more potent in clearing the bacteria. The shorter duration is more likely to increase adherence to therapy and improve treatment outcomes. 


  • The need of the hour – The number of those who would need a pretomanid-based regimen is increasing due to rising drug resistance.



    1. There are only a low percentage of MDR-TB cases being treated and the actual number of people who do not tolerate or respond to available MDR-TB drugs is unknown.


  • Affordability – It remains to be seen if it would be made affordable, in the developing countries where the burden of XDR-TB and MDR-TB is the highest. Bdaquiline’s prohibitive cost has severely restricted access in developing countries.


Pricing the new drug

  1. TB Alliance, a New York-based international NGO, which developed and tested the drug, has signed an exclusive licensing agreement with a generic-drug manufacturer for high-income markets.
  2. The drug will be licensed to multiple manufacturers in about 140 low- and middle-income countries, including India.
Tuberculosis Elimination Strategy

India’s biggest ever trial of tuberculosis vaccinesPriority 1


From UPSC perspective, the following things are important :

Prelims level : BCB and other vaccines mentioned

Mains level : Elimination of TB in India

  • The Indian Council of Medical Research (ICMR) has launched India’s first large-scale trial for two new tuberculosis (TB) vaccines.

New Vaccines

There are two vaccines being tested in the latest trial:

  • Immuvac (also known as mycobacterium indicus pranii or MIP), which is manufactured by Cadila Pharmaceuticals in Ahmedabad, and
  • VPM1002 manufactured by Serum Institute of India in Pune.

Why need new vaccines?

  • Scientists at the ICMR have felt a critical need for new TB vaccines that are more effective than the Bacille Calmette-Guerin (BCG) vaccine.
  • The BCG vaccine is used in the routine Expanded Programme of Immunisation (EPI) in countries across the world. It is generally given at birth or in the first year.
  • The vaccine is over 100 years old and, while it has been partially effective in protecting infants and young children, particularly from the most severe forms of TB.
  • It provides poor protection against pulmonary disease in adolescents and adults.
  • It is for these reasons a need was felt to develop more effective preventive TB vaccines.

Rise of MDR TB

  • The new vaccines that are being put through the trials offer a chance to contain the accelerating spread of multi-drug resistant TB.
  • Treating TB requires a multi-drug course of treatment lasting six months; longer still for treating drug-resistant TB.
  • Treatment failure and recurrence can have devastating consequences.

Incidence of TB in India

  • India contributes to 27 per cent of the global TB burden; the highest share globally. That is why, in 2017, the central government had committed itself to eliminating TB by 2025.
  • As per the 2018 annual report of the Central TB division of Ministry of Health, the incidence of TB was nearly 2.8 million annually, and the incidence of multidrug-resistant TB was 1,47,000 per year.
  • The total number of deaths because of TB (excluding HIV) was 4,23,000, and the incidence of HIV-TB was 87,000 per year.
Tuberculosis Elimination Strategy

[op-ed snap]Paradigm shift for TB controlop-ed snap


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: Not Much

Mains level:Tamilnadu pilot model to curb TB infection as a guide to other initiatives.



Tuberculosis (TB) remains the biggest killer disease in India, outnumbering all other infectious diseases put together — this despite our battle against it from 1962, when the National TB Programme (NTP) was launched.


  • In 1978, the Expanded Programme on Immunisation (EPI) began, giving BCG to all babies soon after birth and achieving more than 90% coverage.
  • In 1993, the Revised National TB Control Programme (RNTCP) was launched, offering free diagnosis and treatment for patients, rescuing them from otherwise sure death.
  • However, treatment is not prevention. Prevention is essential for control.

The effectiveness of these programmes

  • Yet, when evaluated in 1990, the NTP and the EPI had not reduced India’s TB burden.
  • Why did the NTP and the EPI fail?
    • Visionary leaders had initiated a BCG vaccine clinical trial in 1964 in Chingelpet district, Tamil Nadu.
    • Its final report published in the Indian Journal of Medical Research in 1999.
    • It held that BCG did not protect against TB infection or adult pulmonary TB, the ‘infectious’ form.
    • BCG immunisation does prevent severe multi-organ TB disease in young children, and must be continued but will not control TB.
  • By 2014-15, the RNTCP was found to be very successful in reducing mortality, but failing to control TB. Why?
    • From when a person becomes infectious to when he/she turns non-infectious by treatment, there is a gap of several weeks during which the infection saturates contacts in the vicinity.
    • Delays in care seeking and diagnosis are the result of lack of universal primary health care.

Tamil Nadu Pilot Model to control TB infection

  • Tamil Nadu is planning to implement new strategy in one revenue district, Tiruvannamalai.
  • To ensure public participation — a missing element in the RNTCP — the new model will be in public-private participation mode.
  • The Rotary movement, having demonstrated its social mobilisation strengths in polio eradication, will partner with the State government in the TB control demonstration project.
  • Tiruvannamalai, a pioneer district in health management, was the first in India (1988-90) to eliminate polio using the inactivated polio vaccine (IPV).
  • The Directorate of Public Health and Preventive Medicine and the National Health Mission will lead all national, State and district health agencies, district and local administration, departments of education, social welfare and public relations and government medical college.
  • The Rotary will ensure the participation of all players (health and non-health) in the private sector.

Other steps to control TB infection

  • The Rotary will spearhead public education for behaviour modification, starting in all schools and continuing through to adults.
  • Progression to TB disease from infection can be prevented by giving World Health Organisation-recommended short-term ‘preventive treatment’.
  • Infection is silent, but diagnosable with the tuberculin skin test (TST).
  • Cohorts of schoolchildren (5, 10 and 15 years) can be tested and those TST positive given preventive treatment.
  • On March 13, 2018, the Prime Minister, who was inaugurating the End TB Summit, declared that India would end TB by 2025.

Way Forward

  • A strategy of simultaneously using all biomedical and socio-behavioural interventions can help in controlling infection.
  • Ending TB by 2025 is impossible but pulling the TB curve down by 2025 and sustaining the decline ever after is a possibility.
  • Tamil Nadu, an erstwhile global leader in TB research during the 1960s through the 1990s, will now become the global leader in TB control.






Tuberculosis Elimination Strategy

[op-ed snap] Cure In Progressop-ed snap


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: Not Much

Mains level: Global efforts for preventing fatalities due to TB and NCDs.



  • Recently the UN General Assembly deliberated on how best to address a serious public health challenges posed by tuberculosis (TB) and non-communicable diseases (NCDs).

Ground zero in battle against TB and NCDs

  1. The region accounts for 50 per cent of TB-associated mortality, with the disease being the region’s leading cause of death and lost productive years in the crucial 15-49 years old age group.
  2. TB/HIV co-infection is meanwhile responsible for 25 per cent of AIDS-related deaths.
  3. On NCDs, though, the region accounts for a bit over a quarter of the world’s population, it is home to around 29 per cent of NCD-related premature mortality.
  4. Every year, 8.9 million people in the region die of NCDs, accounting for 64 per cent of all deaths which were preventable.

Generating Political Momentum

  1. In recent years, each one of them has shown unprecedented political commitment to tackle TB, as expressed in the 2017 “Delhi Call for Action” and the 2018 “Statement of Action” to end TB by 2030.
  2. That commitment continues to be reflected in on-the-ground action.
  3. The Colombo Declaration of 2016 is committed to integrating NCD services at the primary level each country in the region.
  4. These include a range of ground-breaking initiatives, from nutrient labelling systems that enhance health literacy to promoting physical activity through the provision of outdoor gyms.

UN intervention: The game-changer

  1. The high-level meetings at the UN headquarters provided the region significant scope to consolidate these gains, accelerate progress, and promote game-changing innovations in each of these areas.
  2. The meetings provided the member states an open and global  platform to highlight the problem’s significance and present a detailed outline of how they are addressing it.
  3. It gave them an opportunity to underscore the dramatic increase high-burden countries have made in domestic funding.
  4. It also offered them a chance to emphasise that an increased allocation of resources from the global community could generate momentum in combating the disease.
  5. Much emphasis was placed on harnessing greater investment in research and development — particularly for developing low-cost, affordable diagnostics and drugs to treat the disease.

What brings in the UNGA Platform?

  1. The meeting provided member states the opportunity to highlight progress since the first high-level UNGA meeting was held in 2011
  2. The members reiterated their resolve as to reach the half-way mark in the quest to reduce premature deaths caused by NCDs, by a quarter by 2025.
  3. It gave them an opportunity to highlight the areas which require more spending and how governments can be better supported in implementing their country-specific plans.
  4. That includes emphasizing the significance of preventive measures that are among the most cost-effective (though underfunded) ways to deal with the problem.
Tuberculosis Elimination Strategy

[op-ed snap] More global R&D is needed to tackle TBop-ed snap


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: India TB Research Consortium (ITRC), BRICS TB Research Network, Bedaquiline

Mains level: Global efforts to curb TB and need for more R&D for its cure and elimination


UN special meeting on TB

  1. Tuberculosis (TB) has drawn unprecedented attention in recent times
  2. A growing sense of urgency in dealing with this global threat made the United Nations (UN) schedule its first-ever high-level meeting on TB in New York on 26 September
  3. The meeting offered participating nations the potential to energize the discourse on TB and chart a roadmap for global action on TB
  4. One of the major discussion points focused on accelerating research and development (R&D) efforts to end TB

Gaps in research in TB cure

  1. The lack of advancement in TB R&D is one of the major reasons why the disease continues to thrive and exact a heavy toll on human life
  2. Until 2016, we used a century-old microscopy test that detects only 50% of cases and treated TB patients with long drug regimens that have severe side effects
  3. We are also yet to discover an effective vaccine against the disease

Efforts by India

  1. India has established the India TB Research Consortium (ITRC)
  2. Since its inception, ITRC has raised the profile of TB research, attracted investments in TB product development and conducted several validation studies on new TB tools
  3. The Indian Council of Medical Research (ICMR) has also recently taken steps to initiate trials for two new TB vaccine candidates
  4. Recognizing this, the ICMR, under which the ITRC was formed, was awarded the prestigious Stop TB Kochon Prize for 2017

Intercountry cooperation

  1. An example of such a partnership is the BRICS TB Research Network through which the five nations are working together on multiple research projects covering TB diagnostics, vaccines, new drugs, and infection control
  2. While this is encouraging, more countries must come together not just to collaborate on future research, but to also facilitate cross-learning by sharing the results of their ongoing efforts
  3. By doing so, they would spend less time reinventing the wheel and are likely to get faster results

What else can be done?

  1. It is equally important for countries to quickly adopt new and emerging drugs, therapies, and devices within their borders
  2. This can be done by agreeing to standardize regulatory processes
  3. For example, the ASEAN countries have accepted a set of uniform standards for medical equipment in the region which helps in the easy registration of these devices
  4. Along the same lines, it is vital for countries to update their existing tools based on the latest scientific evidence
  5. The World Health Organization’s new guidelines on the treatment of multi-drug resistant (MDR) TB needs to be adopted swiftly
  6. These guidelines, which recommend the use of Bedaquiline as a frontline medicine to treat MDR TB, will revolutionize TB treatment by minimizing the use of painful injectable drugs that are known to cause serious side effects
  7. We also need to focus more research efforts on developing biomarkers to determine those who are predisposed to develop active TB among the close contacts of TB patients so that efficient preventive therapy can be provided
  8. Shorter and more efficient anti-TB regimens need to be developed to improve the adherence to treatment and decrease the failure and relapse rates
  9. Research for the prevention of transmission of drug sensitive and drug-resistant tuberculosis in the healthcare setting is critical

Way Forward

  1. In the age of globalization, the containment of an infectious disease like TB within borders poses a considerable challenge
  2. The recently concluded meeting saw the endorsement of a political declaration that underscored the criticality of research in our common goal of eliminating TB
  3. Hopefully, this will act as a starting point for countries’ efforts to advance future TB research built on the foundations of a collaborative spirit and a willingness to share individual strengths
Tuberculosis Elimination Strategy

[pib] Health Ministry launches sputum sample transportation Through Dept of PostGovt. SchemesPIBPriority 1


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: Sputum Test, Nikshay 2.0

Mains level: TB elimination strategies



  • A pilot project for utilising services of Department of Post for transport of sputum specimen for TB Diagnosis was launched by the Health Ministry.

TB Sputum Test

  1. The sputum test is often the first TB test to be used in countries with a high rate of TB infection.
  2. Sputum is a thick fluid that is produced in the lungs and the airways leading to the lungs.
  3. A sample of sputum is usually collected by the person coughing.
  4. Sputum microscopy is inexpensive and simple, and people can be trained to do it relatively quickly and easily.
  5. In addition the results are available within hours.

Why postal transportation of Sputum?

  1. Most of the patients are not diagnosed because the specimen does not reach the laboratory due to non-availability of specimen transport mechanisms.
  2. Transport of collected specimen also spares the patient’s from travelling to the reference laboratory.
  3. Prompt transport of specimen followed by efficacious testing will enable appropriate management of the TB patients and reduced disease transmission.

Nikshay Version 2.0

  1. The web-based application of Revised National Tuberculosis Programme, Nikshay Version 2.0 with better user interface and data structures, was also launched.
  2. The web-application is also designed to be mobile friendly, enabling data entry also from the mobile browser.
Tuberculosis Elimination Strategy

[op-ed snap] Ending TBop-ed snap


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: UNGA, TRIPS, Doha declaration

Mains level: International and domestic efforts to end TB and challenges therein


UNGA recognition to ending TB

  1. On September 26, the UN General Assembly will, for the first time, address TB in a High-Level Meeting and likely release a Political Declaration, endorsed by all member nations
  2. This is being done to galvanise investment and action to meet the global target of eliminating TB worldwide by 2035

Access to diagnostics and drugs still a problem

  1. Elimination, which means reducing the number to one case per million people per year, will be impossible without universal, equitable access to affordable, quality TB diagnostics and treatment for anyone who needs it
  2. Issues around access to diagnostics and drugs have been considerably diluted in the most recent draft of the Political Declaration
  3. The latest draft is a watered-down version of the original that actively committed to upholding access to affordable generics for all
  4. Various important provisions have been omitted from the draft:
  • A critical omission is that countries may avail of the various flexibilities under the Trade-Related Aspects of Intellectual Property Rights
  • Second, countries may invoke the Doha Declaration to compulsorily license drugs for use in public health emergencies is absent from draft text
  • The option to de-link the pricing of new TB drugs from the costs incurred in their research and development is also not mentioned

TB is curable

  1. TB is, by and large, easily diagnosable and curable
  2. Each day, thousands of people with TB die, often because of inequitable access to quality diagnosis and treatment
  3. India not only accounts for a fifth of the world’s TB burden, it also has the largest number of people living with multidrug-resistant TB

What is needed to end TB?

  1. The rapid emergence of drug-resistant forms of TB (DR-TB) in many countries brings a fresh set of needs including new and comprehensive diagnostic tests and second-line TB drugs, and health systems trained anew to manage DR-TB
  2. India has set a target to eliminate TB by 2025, ahead of the global targets.
  3. These targets cannot be achieved without access to affordable, quality diagnostics/ drugs

Way Forward

  1. India has fought to retain its status as a maker and distributor of generic medicines, thereby protecting the right to health of people in developing countries
  2. Unless India assumes a leadership role to restore every possible option to protect universal access to TB drugs in the Political Declaration, 2018 may end up being just another brick in the wall
Tuberculosis Elimination Strategy

[op-ed snap] Reaching the unreached: Tuberculosisop-ed snap


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.


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


  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
Tuberculosis Elimination Strategy

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


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


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
Tuberculosis Elimination Strategy

[op-ed snap] The long fight against TBop-ed snap


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


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
Tuberculosis Elimination Strategy

PM launches campaign to eradicate TB by 2025


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

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
Tuberculosis Elimination Strategy

WHO launches plan for cheaper TB drugsop-ed snap


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.

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
Tuberculosis Elimination Strategy

[op-ed snap] Incentivizing new vaccine developmentop-ed snap

Image Source


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


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:
  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
  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
Tuberculosis Elimination Strategy

‘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
Tuberculosis Elimination Strategy

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.
Tuberculosis Elimination Strategy

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.
Tuberculosis Elimination Strategy

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.

Tuberculosis Elimination Strategy

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.
Tuberculosis Elimination Strategy

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
Tuberculosis Elimination Strategy

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.
Tuberculosis Elimination Strategy

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.
Tuberculosis Elimination Strategy

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.
Tuberculosis Elimination Strategy

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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