Drug shortage threatens to derail India’s fight against tuberculosis

Umesh, a 55-year-old resident of Bisrakh Jalalapur in Uttar Pradesh, was diagnosed with pulmonary tuberculosis in January.

He was put on a treatment schedule, and received his medicine without any trouble for the first two months. However, from the third month onwards, there were serious delays in receiving the medicine.

Sometimes, he went without medicine for almost five consecutive days and suffered severe aches.

Double whammy

“I cannot buy medicines from private medical stores; it’s very costly and there is a big demand," Umesh told The Federal. "I got my TB medicine from the government health centre in the initial months, but then, there was a shortage in March. I was asked to get my medicine from the district hospital."

"At one point in early April, when my family was even ready to buy it from a private dealer, it wasn’t available anywhere," he recalled. "The drug supply improved somewhat in the first two weeks of June, but now there is a shortage again.”

Umesh is filled with despair. He is unable to cope with the disease and the shortage of drugs. With him, across India, thousands of TB patients are fighting the deadly disease and also facing the difficulty of drug shortages.

Local procurement

In March 2024, the Central TB Division wrote to all states, asking state-level officials to locally procure drugs for the next three months. But the situation has not improved.

This is not the first time Indian states are struggling with a shortage of TB drugs. In September 2021 and August-October 2023, there were several complaints of TB drug shortages in India.

Many doctors and public health experts wrote to Prime Minister Narendra Modi in March 2024, warning that the shortage could lead to the development of drug-resistant strains of TB in the country.

India’s lofty target

India accounts for 27 per cent of the total TB cases in the world, according to the World Health Organisation (WHO).

The India TB Report 2024 from the Union Health Ministry shows that deaths due to the infection were reduced to 23 per lakh of population in 2023 compared to 32 per lakh in 2015.

However, the target for 2023 was just six per lakh. Reducing mortality and infection is crucial since India has set the goal of eliminating TB by 2025, five years ahead of the global target.

Missed doses

Experts say providing medicines on time and without any delay or interruption is the first step towards elimination.

Renowned Chennai-based pulmonologist Hisamuddin Papa said missing drugs would actually increase drug resistance among TB patients.

“Doctors suggest patients take the entire course of antibiotics even for fever and common cold. Missed doses of TB drugs affect the body badly. When the drugs are provided after a break, the patient’s body may develop resistance, reducing the efficacy of the drug. Missing drugs can affect all organs and can be fatal in some cases,” said Dr Papa.

He also criticised the Centre for failing to address the shortage of drugs and not providing funds to states on time. “The promise by the Indian government to eliminate TB by 2025 is just another lie. There is no commitment or willingness to provide adequate care to TB patients,” he added.

How states are faring

The Federal checked the status of the TB drug shortage in various states and how the state governments are tackling it.

A senior doctor in Noida, who wished to remain anonymous, shared that the district hospitals in Noida had a shortage of anti-tuberculosis treatment (ATT) medication, forcing patients to buy from the open market at high prices.

Shortage in Telangana

The situation in Telangana is no different. There has been a shortage of TB medicines since last year. Funds have not been received for past bills paid by the state TB division.

Dr A Rajesham, Joint Director of the Telangana State TB Cell, told The Federal that first-line medicines for TB prevention are not available, and there is a shortage in the supply of rifampicin, linezolid, clofazimine, and cycloserine, which are essential for treatment.

“The TB cell statistics show that the number of TB cases has increased in Telangana. There were 60,788 TB cases in Telangana in 2021, and this number increased by 20 per cent the following year. The treatment of TB requires expensive drugs. TB can develop if antibiotics are not used properly. Most patients often stop using the medicine midway due to the shortage. To reduce TB, the medicine should be used completely according to the course. TB bacteria can spread if the medicine is not used,” Rajesham told The Federal.

Buffer stock in Tamil Nadu

Asha Fredrick, who heads the Tamil Nadu TB division, told The Federal states were asked to procure drugs on their own but no additional funding was provided by the Union health ministry. She also explained that the health ministry did not keep pace with state-level TB divisions when new cases were reported after the pandemic.

“We had a difficult time last year and have now learned to sail with the tide. Since the Tamil Nadu Medical Services Corporation helped on time, we were able to avoid a severe shortage and ensure a buffer stock. We have asked patients to visit the hospital to take drugs once every two days to avoid wastage during the shortage across the country. We do not want even a single pill to go to waste. The situation is much worse in northern states,” she told The Federal.

Kerala, Andhra, and Bengal

Officials in Kerala and Andhra Pradesh maintained that they handled shortages similar to Tamil Nadu; they are also waiting for funds from the Union Health Ministry to cover the expenses.

Dr Siddhartha Niyogi, Director of Health Services in West Bengal, confirmed that the Union Health Ministry has stopped supplying anti-tuberculosis drugs since March 18 this year.

“The state government procured around 50 lakh strips of ATD from the open market last month. The stock will last about two months,” he said.

Issue resolved in Karnataka

In Karnataka, Dr C Nagaraj, Director of the Central Tuberculosis Institute (RJICD), confirmed that there was indeed a shortage of medicines for TB treatment at the national level. However, he claimed that the issue has been resolved now.

“There was a shortage of medicines for tuberculosis treatment in Karnataka. Three months ago, there was a shortage of Rifampicin, but that problem no longer exists. At that time, the Centre had suggested procuring medicines from the open market. Now, the medicines are available,” he said.

(With inputs by Shaik Saleem in Hyderabad, Naveen Ammembala in Bengaluru, Samir K Purkayastha in Kolkata, and Rajeev Ramachandran in Kochi.)