That India, the pharmacy of the South, should find itself on the brink of a major TB-drug stock-out is at once shocking and shameful. The fact that an antiquated drug-procurement system and incompetent and irresponsible government departments — which dragged their feet for more than two long years to procure the drugs — could have brought us to such a situation tells us how dangerously poised the national tuberculosis control programme is. It is scandalous that no action was taken despite the Joint Monitoring Mission warning the Central TB Division of the precariously low paediatric drug stocks in August last year. Even as the government denies the possibility of a stock-out, the ground reality in some places appears otherwise. While the stocks of some drugs are claimed to last a month, a few are at dangerously low levels. A stock-out has been “confirmed” in the case of some paediatric doses. If denying drugs to new patients is unethical and has serious consequences, the lack of drugs to treat existing patients provides a perfect breeding ground for drug-resistant strains to emerge and is a sure recipe for disaster. The situation becomes all the more dangerous in the case of drug-resistant TB. It is appalling that the utter failure of a few has come so dangerously close to jeopardising the Revised National TB Control Programme, that treats more than 18 lakh patients every year. Waiting till stocks dip to dangerously low levels before resorting to emergency procurement best portrays how serious the government is about confronting a disease that kills three lakh people every year.
With TB prevalence hovering over three million, and actual incidence at two million, India has the highest case load in the world; it has the highest death rate too. At a time when lethal arsenals and novel strategies are required to tame the killer disease, it is unfortunate that the country is floundering on a most vital and fundamental issue that can have a cascading effect. Ironically, “an uninterrupted supply of good quality anti-TB drugs” is one of the five components of the DOTS programme. The current shortcoming raises serious doubts about the government’s ability to meet the increased drug demand when more MDR-TB cases are detected using the advanced molecular test. Hence it is incumbent on the government to ensure assured and uninterrupted supply of drugs. The first step to achieve that is to overhaul the outdated drug-procurement system that takes “approximately 12-16 months.” Union Health Secretary Keshav Desiraju, who inherited the two-year-old problem from his predecessors, has done well to deal with the emergency. What is needed now is a thorough enquiry that gets to the root of the procurement lapse.