UN General Assembly Meeting to Renew Pledge to End TB by 2030
The UN General Assembly is set to convene on September 22, 2023, to renew its commitment to ending tuberculosis (TB) by 2030. However, a recent report from the Lancet Commission has raised concerns about the world’s progress towards achieving its TB-related targets. Mortality rates from TB have increased for the first time in two decades, with India, Indonesia, and Nigeria accounting for nearly 50 percent of the total number of deaths.
India, in particular, is undertaking an ambitious initiative called TB Mukt Bharat Abhiyan, which aims to eliminate TB in the country by 2025. This goal is significant as India contributes more than 25 percent to the global burden of TB, including over 27 percent of drug-resistant TB (DRTB) cases.
Tackling TB in Mumbai is crucial to achieving the Indian government’s objectives, as the city is considered one of the hotspots for TB in the country. According to a report obtained through the Right to Information Act, Mumbai accounted for almost 30 percent of India’s total TB cases in 2021. The number of TB cases dropped in 2020 but rose to 65,617 in 2022, the highest in five years. Mumbai’s case notification rate, which reflects the number of new cases reported per 100,000 people, stood at 183 in 2022, higher than the national average of 172. India aims to reduce the case notification rate to 77 by 2023.
Mumbai also contributes a significant number of drug-resistant TB cases, with approximately 4,000 to 5,000 cases, or 58 percent of Maharashtra’s total, according to data from 2021. Drug-resistant TB occurs when the bacteria that causes TB develops resistance to one or more of the drugs used to treat the disease. Diagnosing and treating drug-resistant TB is complicated and often requires specialized testing and expertise. Treatment is expensive and can lead to severe side effects.
Multiple factors contribute to Mumbai’s status as a TB hotspot, including overcrowding, high prevalence of slums, poverty, malnutrition, and a higher incidence of HIV. Wards in Mumbai such as Ghatkopar, Malad, Dadar, and Govandi have seen significant increases in TB cases. Overcrowding and poor ventilation in slums are believed to contribute to the high numbers. Even when individuals are resettled from slums, their susceptibility to TB may remain unchanged.
The high prevalence of HIV in Mumbai also contributes to the TB burden, as individuals with weakened immune systems are more susceptible to contracting the disease. In 2022-2023, Mumbai accounted for 1,967 HIV cases out of a total of 8,500 cases in Maharashtra.
The National TB Prevalence Report reveals that Maharashtra has a low prevalence-to-notification ratio, indicating that many TB cases go undetected. Stigma, lack of awareness, and poverty can contribute to cases going untreated. Efforts to address TB in Mumbai have been strengthened following the discovery of totally drug-resistant strains in 2012. The BMC (Brihanmumbai Municipal Corporation) has implemented various measures, including the appointment of TB officers for each ward, to oversee logistics and implementation. The city also has numerous diagnostic facilities and was one of the first to start patients on newer drugs recommended by the WHO.
The COVID-19 pandemic has likely contributed to the increase in TB cases, as screenings and detections decreased during that time. Interestingly, Mumbai has bucked the global trend of higher TB incidence among men, with more cases reported among women in the past three years. This could be attributed to the neglect of women’s healthcare during the pandemic, reflecting the exacerbation of pre-existing gender inequalities.
The incidence of TB among children in Mumbai has also been on the rise, from 7 percent in 2019 to 9 percent in 2021.
To meet the 2025 target, the BMC is implementing various measures, such as increasing the number of hospital beds and introducing genome sequencing in patients.