India needs to spend $290mn more yearly on TB control: Lancet

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Lancet Commission on TB  says India should spend US$290 million each year, which is significantly less than India’s US$32 billion annual losses because of TB

 

A world free of tuberculosis (TB) is possible by 2045 if increased political will and financial resources are directed towards priority areas. These include providing evidence-based interventions to everyone, especially to high risk groups, and increasing research to develop new ways to diagnose, treat, and prevent TB. Funding this response will require substantial investments, and accountability mechanisms will be necessary to ensure that promises are kept and targets are reached.

Published ahead of World TB Day (24 March 2019), The Lancet Commission on TB estimates that there are significant financial benefits of reducing TB mortality – the savings from averting a TB death are estimated to be three times the costs, and may be much greater in many countries. India, it estimated, would have to pump in $290 mn more to fight TB.

“This report is optimistic about ending TB – a disease that is preventable, treatable and curable However, there is no room for complacency in our work, and we must act quickly and strategically to save the next generation from TB,” says lead Commissioner Dr Eric Goosby, UN Special Envoy on Tuberculosis, University of California San Francisco, USA. “In the wake of the UN High-Level Meeting on TB, the Commission views this report as a roadmap to help keep high-burden countries accountable for defeating this deadly disease.”

“The Lancet Commission reports the value of the loss associated with tuberculosis mortality to be an estimated $32 billion per year in India. New tools resulting from greater tuberculosis research and development (R&D) are essential to prevent those projected economic losses. With at least 30% of India’s population infected with tuberculosis, we need accurate point-of-care diagnostics for detecting tuberculosis infection and effective person-centred treatment. We need an effective vaccine to prevent tuberculosis”

TB remains the leading infectious killer of our time, responsible for 1.6 million deaths worldwide in 2017, with drug-resistant forms of TB threatening control efforts in many parts of the world. In addition, in 2017, around a quarter of the world’s population were living with TB infection.

The World Health Organization (WHO) first declared TB a public health crisis in 1993, and in 2018 the first-ever UN High-Level Meeting (UNHLM) on TB made ending the disease a global priority. This included ambitious goals to treat 40 million people, and to prevent 30 million new cases between 2018-2022.

Private health care is often the main route to diagnosis and treatment for patients in high-burden countries, meaning countries and donors must engage with the sector to improve care. Modelling demonstrates that subsidising tests and supporting patients to complete treatment in India, the country with the highest TB burden and predominantly private health care, more than one-quarter (28%) of TB deaths could be averted over the next 30 years (an additional 8 million lives). This would cost an extra US$290 million each year, which is significantly less than India’s US$32 billion losses associated with TB mortality each year.

Speaking about the report’s role in India, co-author Dr Nalini Krishnan, Resource Group for Education and Advocacy for Community Health, India, says: “India has shown strong political commitment to ending TB, pledging to eliminate the disease by 2025. The TB Program has moved into high gear, prioritizing person-centered care, engaging the private sector and focusing on prevention. But India must now accelerate on three fronts: involving TB survivors and affected communities as key drivers of the TB response, improving the quality of care of TB services and integrating TB services into the primary health system to reduce diagnostic delays and out-of-pocket expenditure. The Commission’s recommendations with reference to accountability, rapid scale up of proven technologies and investing in research, are important strategic directions to adopt.”

Highlighting policies implemented in India to achieve TB elimination by 2025, India’s Minister of Health and Family Welfare, Jagat Prakash Nadda, writes in a linked Comment: “The Lancet Commission reports the value of the loss associated with tuberculosis mortality to be an estimated $32 billion per year in India. New tools resulting from greater tuberculosis research and development (R&D) are essential to prevent those projected economic losses. With at least 30% of India’s population infected with tuberculosis, we need accurate point-of-care diagnostics for detecting tuberculosis infection and effective person-centred treatment. We need an effective vaccine to prevent tuberculosis. Delivering strong advocacy, in close coordination with the Ministry of Science and Technology and research-oriented pharmaceutical companies, and global commitment and collaboration to tuberculosis R&D are essential to reach our targets… To end tuberculosis, governments of high-burden countries will need to propose bold plans to address tuberculosis rather than be content with moderate incremental gains.”