Dr. Anup Bastola / Dr. V.P. Myneedu 

World Tuberculosis (TB) Day is commemorated on March 24th every year to raise public awareness of the devastating health, social and economic consequences of TB and step up efforts to end this global epidemic. The day is marked in the commemoration of discovery of bacterium (Mycobacterium tuberculosis) by Dr. Robert Koch on March 24, 1882. The detection of bacterium that causes TB made breakthrough in diagnosing and curing this disease. The theme for this year’s World TB Day is ‘Invest to End TB, Save Lives’ which advocates for urgent investment to fight against TB and achieve commitments to abolish TB.

Tuberculosis is an infectious disease that mainly affects the lungs. This is an airborne disease. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes. Though it is airborne disease, it is preventable and treatable illness.

Global efforts
Globally, an estimated 10 million people fell ill and 1.5 million die of TB in 2020. Global efforts have saved some 66 million lives through National TB Programmes between 2000 and 2020. In the SAARC region, estimated annual incidences of 3.6 million TB cases are detected. This is equivalent to 198 cases per 100,000. It accounts for 36 per cent of the global burden of TB incidence in 2020. About 0.6 million people died of TB in 2020. This figure also includes as many as 13,540 people living with HIV. The total TB mortality rate ranges from (2-56)/100,000 population while the treatment success rate stood at 86 per cent. There were 54578 multidrug-resistant TB (MDR/RR-TB) and 9967 extensively drug-resistant (XDR-TB) laboratory confirmed cases. However, 46744 MDR/RR-TB and 9083 XDR-TB patients underwent treatment. The region had an estimated 0.4 million TB burden in children (0-14) years with 56 per cent children (above five years) household contacts of bacteriologically confirmed TB cases on Isoniazid treatment.

Globally, there are 30 each high TB and high DR TB burden countries. Among them, three high TB and four high DR-TB burden countries are in the SAARC region. Major causes of high burden of TB in the SAARC region are rapid urbanisation, high population density, malnutrition, air pollution, rising incidence of non-communicable diseases and unregulated private health sector. In addition to them, education, income, occupation and social supports are some of the factors that have led to a rise in the incidences of TB in the region.

There has been continuous active global and regional commitment to prevent TB. Sustainable Developmental Goals (SDG) targets to end this epidemic by 2030. On September 26, 2018, the United Nations General Assembly held the first-ever high-level meeting on ending TB globally. SAARC member states have adopted similar strategies in alignment with SDGs and UN High Level meeting target.

Ending TB is important in the present context as the COVID-19 pandemic control efforts have resulted in funding gap for many national health programmes, including TB control activities in several countries. TB prevention activities are still lagging behind. An effective and potent vaccine for TB prevention is still a distant dream due to low funding for vaccine development and testing. SAARC member states have developed National Strategic Plans, incorporating the goals to eradicate TB as main strategy through patient-centred services, innovative diagnostics, newer treatments, community involvement, and improving health infrastructure. However, the set goals and targets got adversely affected by COVID-19 pandemic. It has increased mortality, decreased the number of people diagnosed and treated and affected the rights of people. Although huge investments are planned by SAARC member states to strengthen National TB Control/Elimination activities, COVID-19 has slowed the progress of these activities.

Without adequate financial resources, we cannot win the fight against TB and reverse severe impact of COVID-19. In several high burden countries, it has pushed back TB control activities by 12 years which needs to be revamped again in post-COVID era through economically feasible, socially acceptable and easily implementable innovative programmes and researches. It is time to restart, revitalise and step up the anti-TB activities in these countries to ensure effective implementation of TB control through intensifying advocacy, social mobilisation, partnership, research and inter-sectorial effort to achieve the target to end TB by 2030.

The pandemic also hit Nepal’s National Tuberculosis Programme (NTP). About half of its services were interrupted due to initial wave of COVID-19. However, the response of NTP was immediate with development of interim guidelines for management of essential TB services, which addressed majority of issues and challenges faced by TB patients. Budget was proposed for NTP to be integrated into Integrated Health System of the country for effective management of National TB Programme during the time of disasters. Additionally, there is also National Strategic Plan for participation of all communities, collaborating partners and donors for multi-sectoral initiatives to deal with social determinants of TB infection and disease which include poverty alleviation, social education and other development related works through support and guidance to achieve the goal by 2030.

Broader commitment
The slogan of this year’s TB Day seeks to generate more resources for TB control activities in the aftermath of COVID-19. However, the role of National TB Programmes of SAARC member states will be pivotal to plan and generate more resources for TB diagnosis, treatment and prevention. Broader political commitment, innovative actions and policies coupled with robust mechanism for implementation of TB control activities enable to reduce the burden of TB morbidity and mortality, thereby making the region free from the menace of TB.

(Dr. Bastola is Director and Dr. Myneedu is Senior Microbiologist at the SAARC Tuberculosis and HIV/AIDS Centre)