With less than two years left to achieve the ambitious goal set by Prime Minister Narendra Modi in 2018 to “eliminate” TB in India, the pharmacy of the Global South is once again struggling to treat patients with drug-sensitive TB. Shockingly, India is experiencing a TB drug shortage, with increasing frequency. Just seven months ago, there was an acute shortage of critical MDR-TB drugs; disruptions in drug supply, which began with drug-sensitive medicines in 2022 and snowballed to include MDR-TB drugs, lasted for nearly a year. Similarly, in September 2021, India faced a stockout of MDR-TB drug Delamanid.
Delay in diagnosis and treatment initiation are already a huge concern in the TB care cascade. Patients who start therapy but fail to achieve treatment success is another gap. However, addressing this gap, which takes drug availability for granted, will become harder if drug stock outs become a recurring issue. A 2010 study found that non-availability of drugs was responsible for 8% of non-adherent patients missing treatment. Making sure that medicines for different categories of TB patients are always available across India is a no-brainer. That 14 years later and close to the target date of 2025, there is still a shortage of drug-sensitive TB medicines, which are manufactured entirely in India by multiple players, only underscores how poorly the national TB programme is being managed.
Renaming the National TB Control Programme as the National TB Elimination Programme in line with Mr. Modi’s goal without addressing the fundamentals such as drug availability reeks of incompetence and a lack of seriousness in the war against TB. What makes the situation worse is the Health Ministry’s permission to States to procure drugs locally at the last minute, creating huge challenges at the field level. A March 18, 2024 Health Ministry circular to all States mentions that the supply of certain drug-sensitive medicines may get “delayed due to unforeseen and extraneous circumstances”.
While States have been asked to procure drugs locally for a period of three months, the circular also gives an option for States to reimburse the cost of medicines procured by patients in case the district health facilities fail to provide them free drugs.
If the last minute permission to States for local procurement is condemnable, leaving it to the patients to buy medicines themselves, even as a last resort, is abominable, given the poor socioeconomic background of most TB patients. Far from reaching the 2025 goal, India does not seem to have a handle on the most basic elements of TB control.
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