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India's Tuberculosis Control Efforts Deemed Successful

Indian and U.S. health officials say India's efforts to control the spread of tuberculosis has saved 200,000 lives and $400 million in indirect economic costs - eight times the cost of these efforts.

India has more people with tuberculosis than any other country. Each year, the scourge infects two million Indians - one third of the world's total - and kills nearly half a million.

But a report in the New England Journal of Medicine says policies the nation introduced in 1993 have been fruitful in recent years and could make inroads against TB. "India has done a remarkably effective job in the past three or four years in expanding effective tuberculosis control services," said Thomas Frieden.

New York City Public Health Commissioner Thomas Frieden served with the World Health Organization in India for several years. "There was a recognition that this was an unacceptable health problem and that something could be done about it," he said.

In the article, Dr. Frieden and Dr. GR Khatri of India's Ministry of Health point out that more than 40 per cent of the country's more than one billion people now have access to tuberculosis services. Despite a health system they say does not function well, a cadre of 200,000 health workers has been trained, evaluating 3.5 million people and treating 800,000 with a success rate of more than 80 percent, up from only 25 percent in the past.

This makes India's tuberculosis outreach one of the world's largest public health programs, one which Dr. Frieden says has strengthened the country's general health care system. "Implementing a TB control program strengthened the sense of accountability in the system, it strengthened the quality of the laboratory work being done, and in a sense, it demonstrated to people that the government can achieve public good on a mass basis," said Thomas Frieden.

Mr. Frieden estimates that India's TB program has prevented 200,000 deaths so far at an annual cost of $50 million - only five U.S. pennies (5 cents) for every person in the country.

Nevertheless, Drs. Frieden and Khatri say effective diagnosis and treatment do not necessarily lead to rapid reduction in the TB caseload. An important threat is the number of transmissible cases that still exist. They predict that it will be several years before the program will have a discernible impact on disease incidence.

If it does, the editor of the New England Journal of Medicine, Dr. Jeffrey Drazen, says the world will benefit. "The more people there are with tuberculosis in the world, the bigger risk it is for everyone," said Jeffrey Drazen. "This is a time when travel is easy and a disease like tuberculosis can easily be spread from person to person. What's been done in India shows that it can be successfully treated easily and many, many lives saved."

But Thomas Frieden says expansion of the program is far from assured, given India's limited development and health care system and the twin threats of HIV and drug resistant TB. He notes that getting the program into less accessible regions will require continued commitment from India's central and state governments, donor countries, and international organizations.

India has effectively covered half the country. The challenge now is to continue that rapid expansion now and cover the other half. It won't be easy.