Central Idea

• At the One World TB Summit in Varanasi, Uttar Pradesh on March 24, 2023, Prime Minister Narendra Modi called for a fresh approach to the global tuberculosis (TB) elimination response, with innovation and research being central drivers of change. This is a critical step as India and the world look to redefine their TB elimination response. India’s recent progress in TB control efforts and COVID-19 response provides a good reflection point, which offers lessons to address the challenges faced in the fight against TB.

India’s Progress in TB Control Efforts

• Expanded reach and improved detection measures: India’s National TB Elimination Programme has introduced several measures to find, notify, and treat TB cases, resulting in expanded reach and improved detection measures. As a result, the number of TB case notifications has significantly increased, rising from 15.6 lakh in 2014 to over 24 lakh in 2022.
• Innovative approaches: India has adopted innovative approaches to TB management, including engagement with the private sector, launch of social support provisions, and introduction of diagnostic tools and new drug regimens. These measures have improved TB management in the country.
• Increased investment in health research and development: India has recognized the importance of investing in health research and development, especially in recent years. The Mission COVID Suraksha programme to develop vaccines was a good example of a public-private partnership, with clear goals and outcomes. The country has also established centres of excellence, which will facilitate collaboration between Indian Council of Medical Research laboratories and the private sector.
• Expansion of diagnostic tools: India has been working on expanding access to diagnostic tools for TB. Innovations such as nasal and tongue swab-based tests for TB can be a game changer by reducing diagnostic delays, and handheld digital x-ray machines with artificial intelligence-based software can now be taken to villages and urban settlements to screen large numbers of high-risk individuals.
• Introduction of new therapeutic molecules: India has been investing in the development and introduction of new therapeutic molecules for TB treatment. Shorter, safer, and more effective regimens, such as the 1HP regimen for latent TB infections, the four-month regimen (HPZM) for drug-susceptible TB, and the six-month regimen (BPaL/M) for drug-resistant TB, have been developed.

Why there is a Need for Disruptive Approaches and New Tools in TB elimination response?

• Lack of widespread awareness: Despite the progress made by India’s National TB Elimination Programme, there is still a lack of widespread awareness about the disease, which has led to delayed diagnosis and treatment.
• Access to quality care: Many people with TB in India and other developing countries do not have access to quality care, which has led to high rates of morbidity and mortality.
• Limited diagnostic tools: There is a need to expand access to diagnostic tools for TB, especially in rural and remote areas.
• Drug-resistant TB: The emergence of drug-resistant TB has made treatment more difficult, requiring the development of new therapeutic molecules and regimens.
• Need for innovative approaches: Innovative approaches are needed to change the way TB is prevented, diagnosed, and treated.
• Rapidly evolving technology: Advances in technology, such as point-of-care tests, artificial intelligence-based software, and handheld digital x-ray machines, have made it possible to develop new tools to combat TB.
• For example: Innovative technologies such as handheld digital x-ray machines with artificial intelligence-based software and nasal and tongue swab-based tests for TB can reduce diagnostic delays and provide rapid, low-cost diagnostics. Similarly, newer and more effective regimens and repurposed existing drugs for TB can play a crucial role in the long run.

Importance of Prioritizing TB Vaccine Trials

• Vaccines are key to ending the TB epidemic: Vaccines are one of the most effective ways to prevent infectious diseases. For TB, a vaccine would be a critical tool for ending the epidemic, especially for those who are at the highest risk of developing and spreading TB.
• BCG vaccine is not effective for all: The current TB vaccine, Bacille Calmette-Guérin (BCG), is not effective for everyone, especially adolescents and adults who are at the highest risk of developing and spreading TB. Therefore, new and effective vaccines are needed to provide adequate protection.
• Multiple TB vaccine candidates in the pipeline: There are currently over 15 TB vaccine candidates in the pipeline, which have shown promise in pre-clinical and clinical trials. Prioritizing these clinical trials will help identify the most effective vaccine candidates for various community settings and different target groups.
• Cost-effectiveness: Vaccines are a cost-effective way to prevent diseases, and a TB vaccine would be no different. Investing in TB vaccine trials and development would save resources in the long run by reducing the burden of TB on health systems and economies.
• Global impact: TB is a global public health issue, affecting millions of people worldwide. The development of a new TB vaccine would have a significant impact not only in India but also in other high-burden countries.

Facts for prelims: Types of vaccine technologies

How Testing and Diagnosis of TB can be improved?

• Increased access to diagnostic tools: There is a need to increase access to diagnostic tools for TB, especially in rural and remote areas. Innovative approaches such as point-of-care tests (POCTs), including home-based tests, can provide decentralized, rapid, and low-cost diagnostics to provide results within minutes.
• Introduction of new diagnostic tools: New innovations such as nasal and tongue swab-based tests for TB can be a game changer by reducing diagnostic delays. Further, handheld digital x-ray machines (with artificial intelligence-based software) can now be taken to villages and urban settlements to screen large numbers of high-risk individuals, safely and conveniently.
• Strengthening the laboratory network: It is essential to strengthen the laboratory network in India to ensure quality diagnostics, especially in the private sector. Accreditation of private laboratories for TB diagnosis and linking them with the public sector is essential.
• Integration with other healthcare services: TB testing and diagnosis need to be integrated with other healthcare services to improve access and reduce stigma. For example, TB screening can be done in conjunction with diabetes or HIV screening.
• Empowering patients: Empowering patients with knowledge about TB symptoms and diagnostic tests can help increase awareness and improve early diagnosis. TB awareness campaigns can also help reduce stigma associated with the disease.
• Collaboration between public and private sectors: Collaboration between the public and private sectors can improve access to diagnostic tools and reduce the time required for TB testing and diagnosis. The private sector can be leveraged to provide affordable and quality TB diagnostics and treatment.

Need for Appropriate Policy Frameworks

• Smoothening the rollout of proven tools: Creating regulatory and policy frameworks can smoothen the rollout of proven tools to reach people with as little delay as possible. This requires greater collaboration between policymakers, scientists, product developers, and clinical researchers across the country and even across regions.
• Harmonization of standards and regulatory processes: Harmonization of standards and regulatory processes between countries can enable mutual recognition of evidence-based standards and licenses and save critical time towards rollout.
• Addressing the regulatory challenges: Appropriate policy frameworks can address the regulatory challenges of introducing new tools and approaches. This can help reduce the time and cost of clinical trials and shorten the time to market for new tools and products.
• Encouraging innovation: Policy frameworks that incentivize innovation can encourage the private sector to invest in TB research and development. This can lead to the development of new and effective tools for TB prevention, diagnosis, and treatment.
• Supporting public-private partnerships: Appropriate policy frameworks can support public-private partnerships that can bring together the strengths of both sectors to develop and scale up innovative solutions for TB control.

Conclusion

• India’s scientific ingenuity during the COVID-19 pandemic has cemented its position as pioneers in innovation in the life sciences. India must use its G-20 presidency to build a global health architecture that creates equitable access for all. India must use this opportunity to call for the collaborative development of transformational tools and approaches that cater to not only India’s needs but also those of the under-represented but disproportionately affected developing world. TB should no longer be the leading infectious disease killer globally in the 21st century, and India can lead the way.

Mains Question

Q. At the One World TB Summit held at in Varanasi recently, Prime Minister Narendra Modi called for a fresh approach to the global tuberculosis (TB) elimination response. In this light discuss India’s Progress in TB Control Efforts and the need for disruptive approaches and new tools in TB elimination response.

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