Covid-19 must not disrupt TB, malaria control

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February 25, 2021 5:00 AM

A new report highlights the problem of communicable diseases, policy must take note

Against such a backdrop, India can hardly afford to slip up on its national programmes against communicable diseases.Against such a backdrop, India can hardly afford to slip up on its national programmes against communicable diseases.

The pandemic shouldn’t cause India to lose its focus on many largely-preventable, communicable diseases that have become somewhat endemic. Battling Covid-19, of course, is the immediate concern for public health. But a recently-released report by the Centre for Disease Dynamics, Economics and Policy (CDDEP) underscores how vital it is to sustain the momentum against certain diseases while building this for some others. India tops the list of countries on the estimated incidence of TB and reports the third-highest proportion of global annual malaria cases. Apart from these, it also shares a fairly large share of the global burden for a host of other communicable diseases. Adding to the risks are malnutrition which has a retarding effect on immunological development—India has battled this somewhat successfully so far, but it continues to cast a long shadow on health in the country—and the sharp increase in antimicrobial resistance in the country because of rampant misuse in humans and farm animals. As this newspaper has highlighted before, citing data from CDDEP experts, drug-resistant infections cause 58,000 neonatal death annually in the country.

Against such a backdrop, India can hardly afford to slip up on its national programmes against communicable diseases. The fact that India’s TB intervention was lagging that of Bangladesh, which reports the third-highest TB burden in South Asia-South East Asia, on most indicators is quite telling; as per data from the Global Tuberculosis Report 2020 of the World Health Organization cited in the CDDEP report, while India’s best-estimate new case detection rate was 65% versus Bangladesh’s 67%, its treatment success rate for new cases was just 69% versus Bangladesh’s 94%. The fact that the success rate for second-line treatment (adopted for cases that are resistant to first-line drugs) was a much higher 74% for Bangladesh than India’s 46% could indicate that despite its high incidence of multi-drug resistant TB, India’s TB control might still need to get patient-tracking right, especially if the low number is because of cases lost to follow-up. While India targets to eliminate TB in the next four years, the drop in the reported number of TB cases last year—a sign of Covid-19 having interrupted TB detection—would suggest the chances of achieving the target may not be too great. This is not to say that India hasn’t accorded priority to the control efforts—indeed, with significant health and social support programmes, there has been meaningful progress over the years. However, there is still a large gap to bridge, and there is a very real chance of the gap becoming wider because of the pandemic’s disruptive effect.

Similarly, while India has reported significant declines in its malarial burden over the last half a decade or so, its poorest states continue to be the worst-affected by the disease. These are also states where the public health system is quite inadequate. With Covid-19 having severely hit states’ finances, defeating malaria becomes increasingly difficult; there are emerging challenges, too, such as growing resistance to artemisinin (an anti-malarial drug). India needs to assess the problem ahead and design efforts accordingly. Else, it might see the present scenario—where the burden of non-communicable diseases is growing, and that of communicable diseases is waning—reverse, leading to a double whammy where both non-communicable and communicable diseases impose a significant burden on the country.

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