Background Context
- By mid-20th century, TB was sharply declining in the US and Europe due to:
- Improved nutrition, housing, and antibiotics (1950s).
- Over 90% decline in TB deaths in the US by 1980s.
- 1972: U.S. Congress ceased direct TB funding, assuming TB was virtually eliminated.
- But by late 1980s–90s, TB resurfaced globally, even in rich countries.
Relevance : GS 2(Health , Governance , Social Issues)
Three Main Drivers of TB Resurgence in Developed Countries
HIV/AIDS Epidemic
- Immunosuppression from HIV reactivated latent TB infections.
- 1993 US data: HIV-positive patients = 0.5% population but 50% of TB deaths.
- By 2000, HIV was still a major driver of TB mortality.
- Lesson: Comorbidity surveillance is vital; TB and HIV must be jointly managed.
Drug-Resistant TB (DR-TB)
- Poor adherence and incomplete treatment caused Multi-Drug Resistant TB (MDR-TB).
- MDR-TB is costlier, longer to treat, and has a lower success rate.
- 1990s: TB patients not responding to standard drugs indicated rising resistance.
- Lesson: Early detection, drug adherence, and drug development pipelines are critical.
Migration & Global Movement
- TB rates among immigrants in the US were 4x higher than native-born population.
- 1965 Immigration Act led to increased migration from high TB-burden countries.
- Most TB cases among immigrants were diagnosed within 5 years of arrival.
- Lesson: Pre-migration screening, early detection, and integration of migrant health are essential.
Global Wake-Up Call
- 1990s data shock: 8 million new TB cases, 3 million deaths annually.
- Over 2x higher than WHO-reported cases due to underreporting.
- 1993: WHO declared TB a “Global Health Emergency”.
- Global health systems realized TB was not a disease of the past, but a persistent, evolving threat.
Data-Driven Policy Shifts
- Granular data revealed patterns (HIV, resistance, migrant origins) behind TB resurgence.
- Timely data enabled targeted interventions, saving lives.
- Lesson: Real-time data collection, disease modeling, and open access health databases are indispensable in public health.
Impact Since 2000
- TB deaths fell from 2.6 million (2000) → 1.3 million (2022).
- Major progress due to:
- Integrated TB-HIV programs.
- Expansion of DOTS and global financing (e.g., Global Fund).
- Drug-resistance surveillance and second-line treatment protocols.
Relevance for India
- India remains the highest TB burden country globally.
- HIV-TB coinfection, DR-TB, urban slums, and internal migration mirror 1990s US conditions.
- Lessons India can apply:
- Expand TB-HIV integration across all districts.
- Ensure universal DST (drug susceptibility testing) for TB cases.
- Leverage Aadhaar-linked public health records for migrant tracking.
- Focus on nutrition, housing, and poverty reduction to address root causes.
- Increase investment in new TB vaccines, diagnostics, and treatment innovation.
Policy Takeaways
- TB control cannot rely solely on medical treatment — it’s also a social, economic, and data governance issue.
- Early complacency, as seen in 1970s US, can lead to costlier health emergencies.
- TB requires permanent, integrated, and well-funded public health surveillance.
- The real enemy is underestimation and invisibility of disease patterns — not just the bacteria.
Tuberculosis (TB)
- Cause: TB is caused by Mycobacterium tuberculosis, primarily affecting the lungs (pulmonary TB), but can impact other organs (extrapulmonary TB).
- Transmission: Spread through airborne droplets when an infected person coughs, sneezes, or talks.
- Latent vs Active TB: Many carry latent TB without symptoms; it becomes active when the immune system is weakened (e.g., HIV).
- Global Burden: In 2022, ~10.6 million people fell ill with TB; ~1.3 million died (WHO).
- India’s Share: India accounts for ~27% of global TB cases — the highest in the world.
- Drug-Resistant TB: MDR-TB and XDR-TB are difficult to treat due to resistance to standard antibiotics.
- Treatment: Standard regimen includes 6-month multi-drug therapy (e.g., isoniazid, rifampicin).
- WHO Goal: End TB epidemic by 2030 under the Sustainable Development Goals (SDGs).
- India’s Initiative: Pradhan Mantri TB Mukt Bharat Abhiyan aims to eliminate TB by 2025, five years ahead of the global target.
