Targeting old scourges

Targeting old scourges

The reference in the Union Budget to new elimination targets for some major communicable diseases barely hints at the enormous burden carried by millions in India with tuberculosis, kala-azar (leishmaniasis), filariasis, leprosy and measles. It would appear incongruous that an emerging economy with no timetable for universal health coverage and a lack of political will to loosen its purse strings for higher government expenditure has set ambitious deadlines to rid itself of deadly scourges. Last year it was revealed that India has a higher burden of new patients with TB than estimated earlier — 2.8 million in 2015 compared to 2.2 million in the previous year, a quarter of the world’s cases. Having set concrete goals, the Centre must now demonstrate its seriousness by moving away from the flawed policies of the past. The promise of a well-funded five-year scheme to meet the TB challenge beginning in 2017 is welcome, although steady progress towards the new elimination deadline of 2025 will also depend on improved capabilities in the health system to meet the daily drugs requirement and a feeling of ownership at the State level. The World Health Organisation has been pointing to the lack of integration of private practitioners with the national mission on tuberculosis for guaranteed access to drugs, and lack of continuous monitoring of such patients. India’s campaign on leprosy is in reality a ‘post-elimination’ struggle resulting from complacency, since it announced at the end of 2005 that it had eliminated it as a public health problem, based on a rate of less than one person in 10,000 having it. Such self-congratulatory moments weakened both policy focus and funding in some pockets in eastern India, where it exceeded the accepted prevalence rate. Health Minister J.P. Nadda’s admission in the Rajya Sabha that there were 1,02,178 leprosy cases on record as of September 2016, and districts of ‘high endemism’, shows the battle was never truly won. Detecting new cases early and preventing them from progressing to disability-inducing grade two level is crucial, although complete removal by 2018 as envisaged in the Budget may prove difficult. Rehabilitation of patients is also a weak spot. Kala-azar, though underreported and mainly confined to Bihar and Jharkhand, is a promising candidate for elimination in the current year, since the few thousand cases are caused by a protozoal parasite with no animal reservoir; control of the vector, the sand fly, holds the key. If good medical protocol is pursued, pockets of filariasis in many States can be removed. Rehabilitation programmes for these diseases require more resources and policy support.