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New Delhi: India is on its path to close the gap between the number of tuberculosis cases estimated and those detected, and it could soon find all its “missing million” TB patients.

Government figures show the country, worst affected by the deadly bacterial infection, has added around 6 lakh tuberculosis patients to its data since 2016 — the year a study in medical journal The Lancet said over a million TB cases may be missing from India’s official statistics.

In 2019, the detection of TB cases in India reached its highest ever at 23.5 lakh patients, against an estimated 26.9 lakh cases. This is also the highest annual detection. However, over 3 lakh TB patients are still “missing”.

These numbers do not suggest an increase in incidence, but the success of India’s drive to eliminate tuberculosis, according to officials.

In a congratulatory message to all stakeholders last week, Vikas Sheel, Joint Secretary, Health, wrote, “With the efforts of the state teams, TB community and all partners, we today crossed notification of 23 lakh TB cases, a first in the history of RNTCP. We are on the verge of closing the gap between the estimated and detected cases.”

The Revised National Tuberculosis Control Program (RNTCP), now renamed as National Tuberculosis Elimination Program, is a national-level TB eradication scheme.

“We are now entering the elimination phase… We have gathered substantial momentum. However, a long way to go and can’t take foot off the pedal,” wrote Sheel, who heads the TB elimination programme run by the health ministry.

The Narendra Modi government aims to rid India of TB by 2025, five years ahead of the target set under the UN Sustainable Development Goals. The increased focus has resulted in a 300 per cent increase in the funding for control and treatment — from Rs 640 crore in 2016-17 to Rs 2,840 crore in 2018-19.

Nearly 100 crore people are suffering from TB globally. India accounts for around 27 per cent of these cases, according to a World Health Organization (WHO) report.


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Finding the ‘missing million’ patients

In 2016, a study by The Lancet estimated that over a million tuberculosis cases could be missing from official statistics. While official estimates put the number of TB cases treated in the Indian private sector in 2014 at around 8 lakh, researchers’ analysis of drugs sales suggested the figure could exceed 20 lakh.

India reported 17.5 lakh TB patients in 2016, 18.5 lakh in 2017 and 21.56 lakh in 2018. WHO’s Global TB report in 2019 pegged the estimated TB cases in India at 26.9 lakh, according to government data.

“For a long time, the main challenge in India has been missed and misdiagnosed TB. The increasing TB notifications is very encouraging,” said Anant Bhan, adjunct professor and researcher in bioethics at Mangaluru’s Yenepoya, a deemed university.

“It also reflects a greater involvement and support by the private sector, where many TB patients access care. However, we need to ensure quality, accessible care, supporting patients to stay on evidence based treatment, reduce stigma and discrimination, and a strong focus on prevention, and social determinants as we move ahead.”

Why notifying TB cases is important

Under-reporting of tuberculosis cases hampers the government’s planning as it fails to understand the prevalence of the disease.

The contagious infection requires treatment of six months, due to which the government needs to ensure the availability of free doses in the country and follow-up with the patients to complete the course. If not treated well, the disease could relapse, and also spread.

With under-reporting hampering data collection and preventing researchers from understanding the prevalence of TB, the health ministry criminalised non-reporting of tuberculosis in 2018.

Now, the medical community including doctors, hospital authorities, chemists and druggists could face a jail term for not notifying TB cases to the government.

The government also launched an initiative — the Joint Effort for Elimination of TB (JEET) Project — under which doctors in the private sector are given an incentive of Rs 1,000 for every case notified to the government.


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