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Recently the UN General Assembly deliberated on how best to address a serious public health challenges posed by tuberculosis (TB) and non-communicable diseases (NCDs).

Why is Tuberculosis a major cause of concern?

  • TB is the ninth leading cause of death worldwideand the leading cause from a single infectious agent, ranking above HIV/AIDS.
  • TB is an infectious disease caused by the bacillus Mycobacterium tuberculosis.
  • It typically affects the lungs (pulmonary TB) but can also affect other sites.
  • The disease is spread when people who are sick with pulmonary TB expel bacteria into the air, for example by coughing.
  • Broader influences on the TB epidemic include levels of poverty, HIV infection, under nutrition and smoking.
  • Diagnostic tests for TB disease include – Rapid molecular test, Sputum smear microscopy, Culture-based methods
  • Without treatment, the mortality rate from TB is high.

Drug-resistant TB(MDR-TB) has been a continuing threat.

  • The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease.
  • Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
  • In 2016, there were 600 000 new cases with resistance to rifampicin (RRTB) of which 490 000 had multidrug-resistant TB (MDR-TB).
  • Globally, the TB mortality rate is falling at about 3% per year. TB incidence is falling at about 2% per year.
  • Most high TB burden countries have major challenges ahead to reach SDG targets related to these and other determinants.

Strategies to end TB

  • From 2000 to 2015, global and national efforts to reduce the burden of tuberculosis (TB) disease were focused on achieving targets set within the context of the Millennium Development Goals (MDGs) established by United Nations.
  • In 2016, the MDGs were succeeded by a new set of goals, known as the Sustainable Development Goals (SDGs).
  • The consolidated goal on health is SDG 3. One of these targets, (Target 3.3), explicitly mentions TB.
  • SDG 3 also includes a target (Target 3.8) related to universal health coverage (UHC) in which TB is explicitly mentioned. This includes an indicator on the coverage of essential prevention, treatment and care interventions.
  • Emphasis is also given to the importance of death registration within national vital registration systems for accurate tracking of causes of death (WHO Global Task Force on TB Impact Measurement).

The End TB Strategy

  • The overall goal is to “End the global TB epidemic”, and there are three high-level, overarching indicators and related targets and milestones.
  • The three indicators are: the number of TB deaths per year; the TB incidence rate per year; and the percentage of TB-affected households that experience catastrophic costs as a result of TB disease.
  • The 2035 targets are a 95% reduction in TB deaths and a 90% reduction in the TB incidence rate, compared with levels in 2015.
  • The 2030 targets are a 90% reduction in TB deaths and an 80% reduction in the TB incidence rate, compared with levels in 2015
  • Two new TB drugs, bedaquiline and delamanid, have already received accelerated or conditional regulatory approval based on trial results and is now in next stage trials.

Achieving these targets requires,

  • Provision of TB care and prevention within the broader context of universal health coverage,
  • multi-sectoral action to address the social and economic determinants and consequences of TB
  • Technological breakthroughs by 2025 so that incidence can fall faster than rates achieved historically.

Present issues in India

  • The government has committed to achieve a ‘90-90-90 target’ by 2035 (90% reductions in incidence, mortality and catastrophic health expenditures due to TB). This is premised on improved diagnostics, shorter treatment courses, a better vaccine and comprehensive preventive strategies.
  • However, much work remains to improve case notifications as only 1.9 million TB cases in the public and private sectors were notified in 2016, leaving a 25% gap between incidence and notification, the largest in the world.
  • Though notification was made mandatory in 2012, multiple surveys and surveillance data still show large under-reporting of detected TB cases, especially in the private sector.
  • Top-line drugs are still inadequate to treat people who suffer from the drug-resistant forms of the disease.
  • The number of estimated multi-drug-resistant TB cases increased marginally to 84,000. But the number of people with MDR-TB enrolled for treatment improved marginally between 2015 and 2016.
  • For the first time, steps have been taken to offer preventive TB treatment to a small (5%) number of people who are HIV-positive, and 1.9% of children below five years who are household contacts of people recently diagnosed with pulmonary TB.
  • Notably, domestic funding (74%) for anti-TB work has been more than that from international sources (26%).
  • The surveillance systems remain inadequate.

Ground zero in battle against TB and NCDs

  • The region accounts for 50 per cent of TB-associated mortality, with the disease being the region’s leading cause of death and lost productive years in the crucial 15-49 years old age group.
  • TB/HIV co-infection is meanwhile responsible for 25 per cent of AIDS-related deaths.
  • On NCDs, though, the region accounts for a bit over a quarter of the world’s population, it is home to around 29 per cent of NCD-related premature mortality.
  • Every year, 8.9 million people in the region die of NCDs, accounting for 64 per cent of all deaths which were preventable.

UN intervention: The game-changer

  • The high-level meetings at the UN headquarters provided the region significant scope to consolidate these gains, accelerate progress, and promote game-changing innovations in each of these areas.
  • The meetings provided the member states an open and global  platform to highlight the problem’s significance and present a detailed outline of how they are addressing it.
  • It gave them an opportunity to underscore the dramatic increase high-burden countries have made in domestic funding.
  • It also offered them a chance to emphasise that an increased allocation of resources from the global community could generate momentum in combating the disease.
  • Much emphasis was placed on harnessing greater investment in research and development — particularly for developing low-cost, affordable diagnostics and drugs to treat the disease.

What brings in the UNGA Platform?

  • The meeting provided member states the opportunity to highlight progress since the first high-level UNGA meeting was held in 2011
  • The members reiterated their resolve as to reach the half-way mark in the quest to reduce premature deaths caused by NCDs, by a quarter by 2025.
  • It gave them an opportunity to highlight the areas which require more spending and how governments can be better supported in implementing their country-specific plans.
  • That includes emphasizing the significance of preventive measures that are among the most cost-effective (though underfunded) ways to deal with the problem.

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