TB - The Silent Killer
For several thousands of years, the aetiology of tuberculosis (TB) remained a mystery and this most dreaded scourge of mankind consumed many millions, earning the nickname “Captain among men of death.” Thanks to the epoch-making discovery of Tubercle Bacillus on March 24, 1882, by Robert Koch, the legendary German microbiologist, both aetiology as well as the pathogenesis of tuberculosis was validated, leading to a scientific approach to its management that includes early case detection and institution of appropriate short course chemotherapy. During the last two decades, 63 million lives were saved globally, by implementing TB treatment strategies and there has been a steady decline in annual incidences. Before the modern-day chemotherapeutic era, many were condemned to death in isolation, the majority dying within five years of the development of the disease.
Approximately 10 million people in the world had active tuberculosis in 2019 with 1.4 million succumbing to it. These figures may be an underestimation since, many developing countries where 95 percent of such cases live, have poor access to universal health care. India has the dubious distinction of being a global epicentre of TB, accounting for 1/4th of global morbidity and mortality due to the disease. India, the most populous country in the world, has about two million TB cases including nearly 1.4 lakh multi-drug resistant ones and daily, about 1400 people die of TB, with annual estimated death of 4.40 lakh cases.
TB control in India
The Tuberculosis control programme under the Ministry of Health, Government of India, during the last six decades has been striving relentlessly to control the disease by incorporating modern-day technology and latest guidelines for early case detection and treatment of active cases. With public and private participation, honest efforts are on to reach out to every part of the country to make the programme a success so as to ‘End TB by 2025’. Undoubtedly, India is far ahead of many countries in programme implementation with a declining trend in various epidemiological indices and if this trend continues, India can find a pride of place for achieving the target much ahead of many other countries having very high TB burden. Tuberculosis should have been totally controlled if not eliminated, by now, and failure to do so has been contributed by a sudden explosion of TB cases among HIV cases and the development of drug-resistant tuberculosis. Further, TB control has taken a beating with the Covid pandemic gripping the nation despite achieving significant success at the grassroots level during the last two decades.
Daunting task ahead
In India, a complex web of healthcare systems involving both government and private sector, containing the disease to achieve ‘End TB by 2025’ is a daunting task demanding herculean efforts at every level of programme implementation. The World Health Organisation (WHO) has realised that much needs to be done to achieve ‘End TB by 2030’ globally. It has demanded urgent measures from all stakeholders and has cautioned them that time is running out and the clock is ticking fast. For realising this vision of ‘End TB’, unity of purpose, universal access to healthcare facilities and strict implementation of TB control with a ‘no-nonsense results-oriented time bound approach’, and plugging all the loopholes are most essential. These are extraordinary times requiring extraordinary efforts if our fight against TB has to succeed.
Yes, we can end TB by 2025
World Tuberculosis Day 2023 theme – ‘Yes! We can end TB!’ can be achieved, provided there is high-level leadership, increased investments, faster uptake of new WHO recommendations and adoption of innovations, accelerated action and multi-sectorial collaboration. Time is short and the efforts needed are herculean. The year 2023 is critical to push forward the agenda towards ending TB on due date. Considering India’s track record in containing the Covid pandemic, despite many odds, it is eminently possible, but through the collective will of both the state and the people.
Lessons from Covid-19 pandemic
The pandemic has reminded us that with a willing government and the people, it is possible to make a difference for the better, notwithstanding many difficulties. The entire nation showed solidarity in stringently following all measures as deemed appropriate to contain the raging pandemic. Mortality and morbidity due to TB is significant when compared to those due to Covid infection. Unless we act unitedly, with the same intensity and passion, as is being shown during the present pandemic, our fight against TB is unlikely to succeed.
Future of TB eradication
One can assume with certainty that tuberculosis cannot be wiped out from the globe in the near future, unlike smallpox, despite tremendous advancements in the understanding of the disease. This disease has survived for thousands of years and therefore, is likely to survive in the future as well, due to the vulnerability of the human host, thanks to modern-day lifestyle and indiscriminate use of antimicrobials. It has been established that the ability of the human body to resist infection is highly dynamic and is influenced by both genetic and environmental factors including microbiota, especially the gut flora. It is a known fact that trillions of microbes which dwell inside the human host are symbiotic in nature offering protection from many dreaded diseases including cancer, degenerative disorders and superinfection due to overuse of antibiotics. When the human host is weak and vulnerable, TB is going to stay. A holistic approach of harmonizing micro and macro-environment that is combined with early detection and appropriate therapy of both active and latent tuberculosis respectively can, one day, make our globe ‘TB Free’ but that day seems to be not so near. The real antidote to tuberculosis is a healthy society that is not only free from the disease but also happy and secure.
The author is Former Director General Hospital Services (Armed Forces), Chief Consultant Medicine & President’s Honorary Surgeon. The views expressed are personal.
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