‘Who Is Answerable?’: Activists Sound Alarm Over Yet Another TB Drug Shortage

World TB Day | "How is such frequent shortage of essential TB medication acceptable?" ask survivors and activists.

TB drug shortage in India.

(Photo: iStock/Altered by Chetan Bhakuni/FIT)

"They tell us medication is critical and that not taking medication is equal to a crime, but then they don't have any for us. Who is committing the crime then?" lamented Suresh* (name changed), husband of a tuberculosis patient, back in September 2023, when parts of India faced a massive shortage of anti-tuberculosis drugs that left families like his running from pillar to post trying to stock up on the pills.

Fast forward to just six months later, and several regions in the country are once again staring at a tuberculosis drug shortage, putting the health of lakhs of TB patients at risk.

"This time we are going to be very aggressive because this is unacceptable," says Ganesh Acharya, a TB/HIV survivor and activist, based in Mumbai.

TB Drug Shortage... Yet Again

On 18 March, the Central TB Division (CTD) of the Ministry of Health and Family Welfare put out a circular informing of a tendering issue in the procurement of drug-sensitive anti-TB drugs — DSTB-IP(A) and DSTB-CP(A).

The letter warns that the supplies may be delayed "due to unforeseen and extraneous circumstances."

Letter from the Ministry of Health and Family Welfare to state TB officers.

(Photo: Accessed by The Quint)

A similar letter was sent from the Chhattisgarh state health department to the districts, on 15 March, asking them to buy TB medicines (3FDC) from the state budget locally.

Commenting on the letter, Acharya says, "They have asked local governments to procure and keep a stock of the drugs for the next three months. But how can they procure and keep such a huge amount of drugs on such short notice?"

"They haven't said how they can acquire it either," he adds.

"There have been stockouts in the past as well, and this is a recurring issue," says Ashna Ashesh, a TB Survivor and a public health professional, associated with Survivors Against TB (SATB).

A similar shortage of the same drug-sensitive anti-TB drugs was reported in 2013 as well.

With doctors, activists, and patients forced to scramble to arrange for the essential medication in the face of frequent and sudden anti-TB drug shortages, the questions that arise are, why do we keep ending up in a situation such as this? And, what of the patients who depend on these life-saving drugs?

'The Shortage Is Widespread, and So Is the Impact'

Speaking to FIT, Dr Chetanya Malik, a physician, who works in the Surguja district of Chhattisgarh, says they have already been seeing their stocks dwindle in the last couple of months.

"Earlier we used to ask other neighbouring districts, or even the neighbouring states when we faced a shortage, but now all the districts in Chhattisgarh, and even the nearby states, are also facing this issue," he adds.

"The shortage has also reached bigger cities like Mumbai," says Acharya, adding, "There are around 65,000 patients on this drug in Mumbai. They are struggling." 

Apart from Chhattisgarh and Maharashtra, Bihar is also reportedly facing a widespread shortage.

"DS-TB drugs are meant for people who have TB that is sensitive to the drugs. Unlike last year's shortage of drug resistant TB (MDR-TB) medicines, this shortage will impact more than 20,00,000 people in India."

Ganesh Acharya, TB Survivor and Activist

For Patients, the Process Is the Punishment

According to the Central TB Division's letter, the tender for procurement of the drugs has been initiated. However, in the meantime, patients and doctors are left to find ways to close the gap themselves.

Dr Malik says that the NGO he works with is tackling the shortage by prescribing patients the individual drugs separately instead of the fixed dose combination that is given by the government.

"Most patients need the fixed-dose combination. Individual drugs are rarely prescribed now because scientifically there is stronger evidence to use the former to avoid a large number of pills."

Dr Chetanya Malik, Physician

He goes on to say, "giving it this way requires them to take around 8-10 tablets a day. This would affect compliance. Calculating the correct dosage for each drug for each patient can be tricky too."

What happens to a TB patient who doesn't take the drugs regularly?

Irregular and insufficient medication can lead to detrimental consequences, not only to the health of the patient but also to others around them.

1. The patient may not recover completely, and can go from having drug-sensitive TB to drug-resistant TB.

"If that happens, all these medicines would stop working on them and they would have more complications," says Dr Malik.

2. More drug-resistant TB and partial recovery also means more widespread disease in the community.

"We're trying to eradicate TB, but if patients don't get medication on time, it would only end up worsening the situation in the community."

Dr Chetanya Malik, Physician

'Frequent Drug Shortages Must Stop'

According to Ashesh, "The TB medication shortage during the COVID-19 pandemic taught us that it is important to keep buffer stocks and factor in future preparedness in stocking exercises."

She adds that having a centralised or statewise reporting mechanism for patients to notify a shortage in their area can also help. "At least there will be a record of what’s happening on the ground and the government can get the information they need to act on time."

"We see Amazon deliveries happening in the most remote areas, and here we are talking simply the delivery of TB drugs that have been continuously required for many years," says Dr Malik.

"TB has been around for a hundred years, and these drugs have been around for years too. How is such a shortage again and again acceptable? If we have a goal to create 'TB Mukt Bharat', it should also have a practical path," adds Acharya.

On 22 March, several TB survivors, activists and public health workers released an open letter addressed to the Prime Minister to draw attention to the stockouts.

The letter co-signed by the Co-Convenor of Jan Swasthya Abhiyan and 50 other TB networks and individuals urges the Central government to undertake emergency procurement and reallocation of stocks to DOTS (Directly Observed Treatment) centres experiencing stock-outs and shortages of anti-TB drug.