Estimated TB deaths in India rose from 4.45 lacs in 2019 to 5 lacs in 2020

The report further said that India accounted for 34% of the combined total number of TB deaths. For India, the TB case fatality ratio (estimated mortality/estimated incidence) went up from 17% in 2019 to 20% in 2020, it said. The report highlighted how covid-19 pandemic has reversed years of global progress in tackling tuberculosis and for the first time in over a decade. The first challenge is disruption in access to TB services and a reduction in resources. In many countries, human, financial and other resources have been reallocated from tackling TB to the covid-19 response, limiting the availability of essential services, said the WHO report. The second is that people have struggled to seek care in the context of lockdowns, it said.

The report noted that reduced access to diagnosis and treatment resulted in an increase number of deaths due to TB. Best estimates for 2020 are 1.3 million TB deaths among HIV-negative people (up from 1.2 million in 2019) and an additional 214,000 deaths among HIV-positive people (up from 209,000 in 2019), with the combined total back to the level of 2017.

Ten countries collectively accounted for 74% of the global gap between estimated TB incidence and the number of people newly diagnosed with TB and reported. The top three contributors were India, Indonesia and the Philippines (24%, 11% and 8.3% respectively).

India also features in all three WHO global lists of high-burden countries for TB, HIV-associated TB and Multidrug-resistant tuberculosis (MDR-TB)/rifampicin-resistant TB (RR-TB) to be used by the WHO for the period 2021–2025. The most obvious impact of the covid-19 pandemic on TB services, is the large global drop in the number of people newly-diagnosed with TB and reported in 2020, compared with 2019. There was a fall of 18% between 2019 and 2020, from 7.1 million to 5.8 million.

India contributed the most to the global drop between 2019 and 2020 (41% drop), followed by Indonesia (14%), the Philippines (12%) and China (8%). These and 12 other countries accounted for 93% of the total global drop of 1.3 million. “This report confirms our fears that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.”

India reported 1.8 million TB cases in 2020 compared to 2.4 million cases in 2019 bringing the TB treatment coverage (notified/estimated incidence) from 82% in 2019 to 63% in 2020. The report showed that in India, those tested for RR-TB stood at 98%, which is a strong increase from 77% in 2019. According to the report, out of the 30 high MDR/RR-TB burden countries, 18 reached coverage of testing for rifampicin resistance of more than 80% in 2020 including India. However, in line with global trends, those with MDR/RR-TB started on treatment in India saw a decline from 56,569 in 2019 to 42,505 in 2020.

The report also showed that an analysis of the percentage of the general population facing catastrophic health expenditures (SDG 3.8.2) in 30 high TB burden countries revealed that for India close to 20% of the general population faced catastrophic health expenditure.