India accounts for 28% of 10.6 million TB cases in 2021: WHO report
This is the first time in several years that an upward trend has been reported in the number of people developing both TB and DR-TB, something that experts attribute to the ongoing Covid-19 pandemic.
New Delhi: Around 10.6 million people across the world were diagnosed with tuberculosis (TB) in 2021, an increase of 4.5% from 2020, while 1.6 million patients died of the bacterial disease, according to the World Health Organization’s 2022 Global TB report.
With 28% cases, India was among the eight countries accounting for more than two-third (or 68.3%) of the total TB patients’ count, said the report, released on Thursday.
The other countries were Indonesia (9.2% cases), China (7.4%), the Philippines (7%), Pakistan (5.8%), Nigeria (4.4%), Bangladesh (3.6%) and the Democratic Republic of the Congo (2.9%).
Of the total TB deaths, 187,000 patients were also positive for HIV (human immunodeficiency virus). Nearly 82% of global TB deaths among HIV-negative people occurred in the African and South-East Asia regions, with India alone accounting for 36% of such deaths, the report said.
“If the (Covid-19) pandemic has taught us anything, it’s that with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threats,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “Let’s apply those lessons to tuberculosis. It is time to put a stop to this long-time killer. Working together, we can end TB.”
The burden of drug-resistant TB (DR-TB) also increased by 3% globally between 2020 and 2021, with 450,000 new cases of rifampicin-resistant TB (RR-TB) being reported in 2021.
This is the first time in several years that an upward trend has been reported in the number of people developing both TB and DR-TB, something that experts attribute to the ongoing Covid-19 pandemic. TB services, among many others, were disrupted by the Covid-19 pandemic in 2021, but its impact on the TB response has been particularly severe, the report said, quoting experts.
Continued challenges with providing and accessing essential TB services have meant that many people with the bacterial disease were not diagnosed and treated. The reported number of people newly diagnosed with TB fell from 7.1 million in 2019 to 5.8 million in 2020. There was a partial recovery to 6.4 million in 2021, but this was still well below pre-pandemic levels.
India was among the three countries — others being Indonesia and the Philippines — that accounted for most of the reduction in 2020 (67% of the global total). They made partial recoveries in 2021, but still accounted for 60% of the global reduction compared with 2019, according to the report.
Underreporting is still a big concern globally, the report said, but more so in India.
Ten countries collectively accounted for 75% of the global gap between estimated TB incidence and the reported number of people newly diagnosed with the disease. The top five contributors were India (24%), Indonesia (13%), the Philippines (10%), Pakistan (6.6%) and Nigeria (6.3%).
Gaps, according to the report, are due to a combination of underreporting of people diagnosed with TB and underdiagnosis (owing to people with TB being unable to access health care or not being diagnosed when they do). From a global perspective, efforts to increase levels of case detection are of particular importance in these countries.
“Due to Covid-19, certain programmes did get affected initially but things were put back on track almost immediately,” said a senior official from the Union health ministry, requesting anonymity. “Several initiatives have been launched to ensure India’s TB elimination deadline — which is 5 years earlier than the global target of 2030 — is met.”
The official further said that through the Ni-kshay Mitra initiative, community support is being provided to TB patients by promoting citizens to adopt one or more patients, to primarily meet their nutritional requirements that will help them recover smoothly.
The 2022 report features data on trends of disease and the response to the epidemic from 215 countries and areas, including all 194 WHO member states.
Reductions in the reported TB cases suggest that the number of people with undiagnosed and untreated TB has grown. It has resulted first in an increased number of TB deaths and more community transmission, and then, with some lag-time, increased numbers of people developing TB, it said.
The number of people provided with treatment for RR-TB and multidrug-resistant TB (MDR-TB) has also declined between 2019 and 2020. The reported number of people receiving treatment for RR-TB in 2021 was 161,746, which is only about one in three of those in need.
The report notes a decline in global spending on essential TB services from US$6 billion in 2019 to US$5.4 billion in 2021, which is less than half of the global target of US$13 billion annually by 2022. In the previous 10 years, most of the funding used in 2021 (79%) was from domestic sources. In other low-and middle-income countries, international donor funding remains crucial. The main source remains the Global Fund to Fight AIDS, Tuberculosis and Malaria.
More positively, TB preventive treatment for people living with HIV has far surpassed the global target of 6 million during 2018-2022, reaching over 10 million in the four years.
Seven countries — India, Nigeria, South Africa, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe — collectively accounted for 82% of those started on preventive treatment in 2021.
The report reiterates its call for countries to put in place urgent measures to restore access to essential TB services. It further calls for increased investments, multi-sectoral action to address the broader determinants that influence TB epidemics and their socioeconomic impact as well as the need for new diagnostics, drugs and vaccines. To intensify vaccine development, the WHO will convene a high-level summit in early 2023.
In 2014 and 2015, all WHO member states and the UN adopted the UN Sustainable Development Goals (SDGs) and WHO’s End TB Strategy which has put 2030 as deadline to end TB globally.
TB, the second (after Covid-19) deadliest infectious killer, is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. It can spread when people who are sick with TB expel bacteria into the air — for example, by coughing.
Most people who develop the disease are adults — in 2021, men accounted for 56.5% of the TB burden, adult women (32.5%) and children (11%). Many new cases of TB are attributable to five risk factors: undernutrition, HIV infection, alcohol use disorders, smoking, and diabetes.
TB is preventable and curable and around 85% of people who develop the disease can be successfully treated with a 4/6-month drug regimen. Treatment has also added benefit of curtailing onward transmission of infection. While TB is detected in every part of the world, 30 countries carry the highest burden.