Recently published findings in The Lancet Infectious Diseases journal that an additional 2.2 million cases of tuberculosis go unreported in India should ring alarm bells in government. For a country already grappling with the highest number of tuberculosis patients in the world, the suggestion of under-reporting is worrying indeed. The key loophole the study shows up is in the surveillance of TB cases being treated by private doctors and hospitals. The suggestion that a large number of private TB cases are “invisible” to the government reporting system is not an entirely new one and the Centre did in fact attempt to plug this gap by making TB a notifiable disease in May 2012. As a result, private doctors and institutions were to report to the government on the cases they treated. But researchers in the past have observed that only a fraction of the private cases get reported. And the recently published study from Imperial College, London, seems to suggest that the problem is bigger than is presently recognised.
India has made an effort to spread awareness on TB through no less than Amitabh Bachchan who calls himself a “TB survivor”. The Big B’s involvement also busted the opaqueness around the disease proving that it affects all strata of society. The Centre’s TB control programmes have tried to improve patient adherence to the regimen by trying to get community members to ensure that a patient takes her or his medication on time and for the mandatory period of six months. Yet, compliance has not been total and as a result, India also faces the worrying scenario of drug resistance (where the illness is not controlled by the first line of medication, as the bacteria evolves due to erratic exposure to the medicine). This means India also becomes fertile ground for multi-drug-resistance TB of varying levels of intensity. In fact, Mumbai’s reporting of drug-resistant TB is only another indicator that no State should sit complacent. They need to check whether zero reports of drug resistance are only because such cases are not being reported. The treatment gets longer and more difficult in such cases.
Surveillance on patients being treated by public and private doctors needs to be made a lot more water-tight and both the States and the Centre need to ensure that enough funds are ploughed into robust reporting systems. But this should not make it laborious or troublesome (or even threatening) for private doctors, else the plot will be lost. Diagnosis should be through globally accepted tests and the Centre needs to support this so that prices do not escalate for the patient. And most importantly, the Centre needs to ensure that there is no shortage of TB drugs across the country. A shortage of essential drugs cannot be condoned in a country that boasts of being pharmacy to the world.