 Hello and welcome to NewsClick. Today, we have with us Dr. Amit Sengupta of the Janasastra Abhyan of People's Health Movement. Amit, India seems to have embarrassed itself quite severely in its performance in the World Lung Conference in Liverpool. What did it do and why has there been such a lot of criticism about that? Well, if it wasn't so sad in terms of what it means for people's health, it was rather amusing India's performance. It was led by the Director General of Health Services Jagdish Prashad. So, this conference was really about discussing current threats to health related to lung diseases. And tuberculosis was one of the focus of the conference. And tuberculosis is by far the largest, at least in middle income and low income countries, the by far the largest threat in terms of lung infections. And the presentation that was when India was supposed to present its progress in controlling tuberculosis, it started with a clip showing Amitabh Bachchan explaining to people how he had contacted tuberculosis at some point in his life and spinal tuberculosis and how he got cured. And that was projected as a major achievement that India had to report in terms of controlling tuberculosis. It glossed over the fact that India actually has done very badly in the last few years in actually in being able to control tuberculosis in the country. And not just that, so the Indian delegation there was confronted by activists who were present in the audience who protested and said that India should say some more about why they have not been successful in controlling tuberculosis to any significant extent. And the Indian delegation had apparently dubbed them as people who are mentally disturbed. Now, this actually typifies the way in which health care is looked at in this country by successive governments and especially by this government. Coming back to what you said earlier, it is a big killer in India, the largest cause of tuberculosis. The WHO has released a study which seems to show that India has done or India has underreported significantly the number of infections on tuberculosis in India. Now, what are the kind of figures and what does it show regarding India's health program, public health program? So, the report basically points to the fact that there seems to be a jump in the number of cases detected, new cases detected between 2014 and 2015 from 2.2 million to 2.8 million. The caveat that the report itself also points to is that these are at best guesstimates. And in fact, what is planned is from next year, there is going to be a surveillance survey done to try to get more accurate data. The Minister for Health, Mr. Nanda, is on record of having said that actually the number of cases have not gone down, but a surveillance mechanism has gone is better, which may or may not be correct. That is not the point. The point that the report is making is that we have far more cases of tuberculosis in the country than what we are planning around. And second, that we have very poor surveillance mechanisms in place for us to be able to accurately determine the number of cases, which in the case of tuberculosis is actually very problematic. Because tuberculosis, as in public health we say, can mimic the symptoms of almost any disease. So, India had a good public health surveillance program for a long time or is it that that program is weakened or is it that only now we are finding out the gaps in the program? See TB was identified even in the colonial times as one of the big killers in India. The momentum of programs started in the colonial times was continued after independence. So, now right through the 60s, 70s, we had a fairly well developed TB control program. It does not mean that it was effective in controlling TB entirely, but at least we had the infrastructure in place. In the 90s and 2000s, this has been replaced by what is called DOTS. DOTS is a program that the WHO advocates now directly observe treatment. Now the DOTS sort of the logic behind the DOTS program itself has been criticized because what it means is that you do not just give out the drugs, you have to come to a health provider and the health provider has to see you taking the medicines which at one level is very paternalistic. You think that people are not capable of taking their own medicines one and second it means that the people who are sickest, who are the most vulnerable are would likely be left out of the program because they cannot come to the health center to take the medicines. That has been one criticism against the DOTS program, but beyond that the data at least that was available seemed to suggest that we are starting to control the problem of tuberculosis from average figures of about half a million people dying every year. The average had come down in plateaued at something like 200 to 250,000 every year, still a very high figure. And just as an aside, if you look at TB deaths in India far, far more than HIV-AIDS ever was in India, even when the numbers were much higher for HIV-AIDS infections. If the numbers are comparison. But what is interesting is that if you look at global funding, if you look at domestic funding, if you look at focus on control of infectious diseases, lots of resources put into HIV-AIDS, it does not mean that it should not have been, but comparatively very much less effort put into tuberculosis. So, there has always been this problem with tuberculosis, except that we had started to believe that it was being controlled to an extent. But the latest WHO figures seem to suggest that that is not really the case. Now, it can only be a conjuncture as to what is the reason for these fairly alarming figures. One possibility is, and this is borne out by data that we have, that there has been now a rise in the number of drug-resistant cases and what are called XDR, extremely extreme drug-resistant cases, which are not responsive to any drug. Now, India has the highest number of both multi-drug resistant and extremely drug-resistant cases in the world. Now, much of the so-called advance that we made in the TB program probably had nothing to do with what we actually did in terms of providing treatment, et cetera, but new drugs that were introduced in the 90s. So, rifampicin, ethambutol really came into the public system in the 90s. Before that, you had to use streptomycin, which required an injection for three months, which put a much larger kind of, which was a much larger drain on the public services in terms of personal required logistics, et cetera. Second, earlier the duration of treatment was 18 months, that was the full duration, whereas now with the new drugs is 6 to 9 months. So, actually by the 90s, treatment of TB relatively became much simpler for the public system to actually be able to deliver. And that would probably explain for a transient period, the downturn in terms of the number of cases that were detected, the number of deaths due to tuberculosis, et cetera. That honeymoon period seems to be now getting over. More people are getting resistant to the existing TB drugs and the system has not expanded to the extent that was required. That is the most important point. Okay. Apart from then showing videos of Amitabh Bachchan, what else can the government of India do with respect to controlling the tuberculosis, spread of tuberculosis, controlling the pool of people who are already infected, reducing mortality, et cetera? See TB has been classically known as the disease of the ghettos. So, urban settlements doesn't mean that you don't get it in rural settings, you do in India quite a lot. But typically in urban settlements, slums where you have congested spaces where people live, thereby able to infect each other and things like that. Now, if you look at urban planning today, the rich believe that they can sanitize themselves, that they can throw out the people so that they are invisible except when they come to their homes or their offices to work, gated communities. Unfortunately, infections don't believe that they don't work on that logic and especially TB doesn't. So, what we have done is we have created pools of infection by ghettoizing further and further people living in conditions where the rich anyway don't have a stake. They didn't speak up for those conditions because they don't even see them, forget live in such conditions. So, there is no one to speak up for these people but these are the pools where diseases like TB will fester and continue to fester. So, of course, we need a much larger expansion of the public health system. But beyond that, TB is finally a disease of living conditions and unless simultaneously you also address the issue of how to provide a kind of enabling living condition which allows people to lead healthy lives especially free from tuberculosis. You will never be just by providing treatment facilities, however much expanded they are, you'll never be able to control it. We'll come back to you further on this and other issues. This is all the time we have with NewsClick today. 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