More bad news on the way for India, TB epidemic larger than imagined, says WHO

Liverpool: Few days after the World Health Organisation (WHO) indicated that Tuberculosis (TB) epidemic in India was larger than previously estimated and revised the TB estimates for India, the International health agency on Thursday said there could be more bad news on its way for India.

Speaking to this newspaper on the sidelines of 47th Union World conference on Lung health in Liverpool, Dr Mario Raviglione, Director, Global TB Programme in the WHO, said that “the burden in India might be even worse”.

Dr Raviglione’s assumption is based on the outcomes of the results from a prevalence survey in Gujarat which was conducted in 2011. This was the country’s first state-wide survey. The results were shared with WHO in 2015 and indicated a prevalence (adjusted for all ages and all forms of TB) of 390 cases per 100000 population. “This is much higher than the national estimate published by WHO in the 2015 global TB report of 250 prevalent cases per 100000 population,” the report had revealed.

According to Dr Raviglione, this was what prompted the WHO to change the estimates. “If Gujarat is a state- that is supposed to be well off, with a good health system, which a GDP better than many other states in India- has a TB rate that is much higher than we estimated for India as a whole than I suspect that the burden in India might be even worse than what we are saying now,” he further said. Adding that, a nationwide survey is needed to know the exact problem. “We don’t know until we have science,” he added.

Dr Raviglione said that a nationwide-prevalence survey and linking the private sector with government policies is an urgent need for India so as to know the real threat.

“India shares the maximum burden and without India we cannot achieve the target. Statistics allowed us to understand that the numbers are at least 3-4 lakh more from the private sector. India and Indonesia are two countries where private sector is huge. The big struggle for India and Indonesia is that you don’t have the private sector involved. There is a need to link the private sector with government policies so that the cases are notified. This was the suspicion going on for two decades but now we have have observational studies and we have more surveys and more evidence, what is needed in India is a nationwide prevalence survey and not just in Gujarat and linkage of private sector,” he pointed.