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Linezolid. Clofazimine. Cycloserine.
These are the three life-saving tuberculosis (TB) drugs that India is currently short of.
What started in 2022 with the shortage of Rifampicin, a drug used for treating drug-sensitive TB patients, has now turned into a full-blown shortage of drug-resistant TB drugs, and it’s concerning.
Usually, drugs or antibiotics like isoniazid and rifampin are used to treat tuberculosis, which is a bacterial infection that mainly targets the lungs.
However, there are certain tuberculosis-causing organisms that these drugs are not effective against.
In such cases, the patients have to rely on stronger drugs like Linezolid, Clofazimine, and Cycloserine to fight against TB.
According to the World Health Organization’s Global Tuberculosis Report 2022, India had the highest share of MDR TB cases in 2021, accounting for 26 percent of the global cases.
To put it simply, taking anti-TB drugs is a matter of life and death for those suffering from tuberculosis.
Ganesh Acharya, a TB/HIV survivor and activist based in Mumbai, explains to FIT that when a TB patient doesn’t take their medication for even a few days, their body starts becoming resistant to it.
In people suffering from MDR TB, the worry is even bigger. These patients are already taking drugs for drug-resistant TB. So when their medication cycle is interrupted, there’s nothing that they can do to prevent the disease from becoming severe.
Chapal Mehra, a public health activist, concurs. He says this is concerning because it can potentially lead to:
People falling off the wagon of treatment and medication.
People having to take loans or borrow money for treatment.
With no guarantee for when the medicines will be available, financial and mental burdens on the patients might increase.
Increasing severity of the disease might increase discrimination or the feeling of resentment towards the patients.
But, he also points out that we can't look at this drug shortage in isolation. It's just as important to see which sections of society it's impacting the most, whether these people have sources of income, who they're dependent on, etc, to get a bigger picture of the TB problem in India.
These drugs are supplied to patients by the Centre under the ambit of the National Tuberculosis Elimination Programme (NTEP). But due to this shortage, the Centre has been diverting requests for these drugs to the states.
Asha Frederick, Tamil Nadu State TB Officer, was quoted by The Hindu earlier in August as saying:
Acharya is also exasperated that the government authorities are expecting people to buy these drugs from private vendors. He asks,
He goes on to tell FIT that many of the patients he’s in touch are unable to continue their medication because of how expensive the drugs are. He says, “This is why marginalised communities are at a greater risk of TB. How can they spend Rs 10,000 per month on drugs alone?”
With this drug shortage, the disparity between those who can and cannot afford the medicines is also increasing.
Leena Menghaney, a lawyer working on medicines, law and, policy, who also heads Médecins Sans Frontières’ Access Campaign in India, says that with TB being one of the deadliest infectious diseases globally, “It's of utmost importance to ensure an interruption-free drug supply and treatment for patients.”
If the drug shortage continues any longer, it would have severe consequences on India’s goal to eliminate the disease by 2025, which is anyway ahead of the global goal to eradicate TB by 2030.
Menghaney explains that sometimes the distribution of drugs is so erratic in some centres that you have more drugs in a centre than patients and sometimes it's the other way round.
Drug shortages also happen when procurement of medicines or their tender/finalisation is delayed at the national and state levels.
But there are certain things that can be done to prevent drug shortages, small and big steps waiting to be taken.
But, she also suggests:
Making the system more transparent so that people are at least aware when a shortage happens.
Encouraging healthcare workers and patient groups to report their needs in an effective manner.
Effective forecasting from centres.
In addition to this, in their letter to the Health Ministry, the TB survivor have demanded that these steps be taken for prevention of drug shortages:
Strengthen and streamline the drug forecasting, procurement, and supply chain mechanisms.
MoHFW to set up a Stock Monitoring Committee consisting of NTEP officials, supply chain experts, and TB community representatives. This committee should meet monthly to prevent and address shortages and stockouts of TB drugs in a timely, transparent, and accountable manner.
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Published: 30 Aug 2023,07:00 AM IST