March 24, every year, is slated to celebrate World Tuberculosis Day to increase efforts to end the global tuberculosis epidemic and to raise public awareness about the health, social and economic consequences of tuberculosis (TB). Dr. Robert Koch in 1882 on this date announced the discovery of a bacterium that caused TB.

What is Tuberculosis?

A bacterium known as Mycobacterium tuberculosis causes Tuberculosis (TB). The bacteria usually attack the lungs, but they can attack any part of the body such as the kidney, spine, and brain, making it more fatal. The strange thing is not everyone infected with TB bacteria becomes sick. So, two TB-related conditions exist i.e., latent TB infection (LTBI) and TB disease. If unchecked properly, TB disease can be life-threatening.

TB is one of the world’s most pernicious infectious diseases killing over 4100 people each day. According to WHO, an estimated 9.9 million people fell ill with TB out of which 1.5 million people died of TB globally in 2020. ‘Invest to End TB. Save Lives.’ was the theme of World TB Day of the year 2022. The theme conveyed the urgency to invest resources to level up the fight against TB and achieve the commitments to end TB made by world leaders. More investment will be required to save millions of more lives, bolstering the end of the TB epidemic.

How does Tuberculosis Spread?

TB bacteria are communicable that is they spread through the air from one person to another. TB disease in the lungs or throat is contagious. For instance, when a person with TB disease of the lungs or throat coughs, speaks, or sings, TB bacteria can get into the air and might infect nearby people as they would breathe in the air. When a person breathes in TB bacteria, the bacteria settle in the lungs and begin to multiply. From there, they can move via the blood to other parts of the body, such as the kidney, spine, and brain.

People with TB when spending time with their family, friends or co-workers, or classmates are more likely to spread the bacteria.

TB in other parts of the body, such as the kidney or spine, is usually not infectious and it is NOT spread by

• shaking someone’s hand
• sharing food or drink
• touching bed linens or toilet seats
• sharing toothbrushes
• kissing

Tuberculosis is more evident in highly populous countries like China, India, Africa, Congo, Indonesia, and Pakistan but it is present in almost every country. The good news is TB is preventable to some extent, treatable and curable. Hence we need timely interventions and create awareness among the masses focusing especially on vulnerable sections of society such as children, women, and old people.

India and Tuberculosis

Being the highest TB burden in the world, India is losing 450,000 people every year to this lethal disease. India had made TB a priority issue, increasing the country’s budget for TB by 70 percent to achieve the goal of ‘ending’ tuberculosis by 2025, set by the Modi government five years ago. The National Strategic Plan (2017-2025) to eliminate TB seeks fivefold drops in the incidence and prevalence of the disease by 2025 from 2015 levels. It has also marked itself the target of reducing the so-called catastrophic expenses on treatment- equivalent to 20% or more of a patient’s annual pre-TB household income- from 35% of afflicted households in 2015 to NIL by 2020.

Reality of Tuberculosis in India

The new study, the first in India, published in the journal PLOS Global Public Health, used samples of economically deprived households from February 2019 to February 2021 to explore the economic conditions of TB patients after treatment. The sampled households had sold or mortgaged jewellery or livestock, even sold land to meet the expenses of treatment. Households had to pay an average of Rs 26,000/- to Rs 30,000/- per patient despite the free diagnosis and treatment.

Patients preferred government hospitals and private clinics equally as was found in the study. Few also approached chemists’ shops and unauthorized people to treat their TB. Poor patients had to run to public hospitals many times before getting the correct diagnosis.

This study is an eye-opener as to figuring out where we stand on our path. It seems we have missed the target of minimizing the expenditure spent on the diagnosis and treatment of TB. India requires a pro-poor model of patient-centric care considering the social and economic circumstances of TB patients.