India’s ambitious goal of eliminating tuberculosis in the country by 2025 is in serious jeopardy. The reason? The repeated instances of a serious shortage of drugs that are essential to treat the disease. If health professionals and patients reported a drugs shortage last year, the past two months have seen doctors, government staff and caregivers scrambling to access drug-sensitive TB medications.
Procurement of TB drugs is centralised under the National TB Elimination Programme. This means that they are procured by the Union government and sent to warehouses in the states based on their indents. However, states have been flagging irregular supply linked to procurement delays. On March 18, by which time the shortage had been reported, the Union health ministry told states to procure the drugs locally for three months. States were also given the option to reimburse patients who bought the medication on their own.
However, the delayed instruction has put states in the tight spot of competing with one another to procure in the open market drugs that are not often stocked by local vendors because their procurement has been centralised and usually given by healthcare providers to patients for free. Meanwhile, TB centres, which normally give patients drugs for three months at a time, are rationing them out, sometimes giving patients medicines just for days.
This makes it harder for patients from low-income groups to complete their treatment course as they may be unable to spend time and money to frequently visit the centres to collect the drugs. The risk of patients not completing the treatment has serious consequences for society, as it will contribute to an increase in multi-drug-resistant TB.
India has the highest TB burden in the world. The push for eliminating TB by 2025, ahead of the sustainable development goal deadline of 2030, is worthy indeed. However, this cannot be accomplished without ensuring that the supply of medication is unhindered. While some instances of TB drug shortages in the past have been linked to global shortages, most recent ones have not. If the government is serious about meeting its goal, the Union health ministry must analyse the procurement process and immediately remove bottlenecks. Lives are at stake.