If the Government has the political will to reach out to vulnerable populations affected by TB, malaria and HIV, it must find the funds to cure them

Consider the following facts: (i) With 2.1 million people living with HIV, India is home to the world’s third largest HIV population. (ii) With 2.7 million new cases of tuberculosis (TB) every year, India has the world’s highest share (27 per cent) of TB cases. With an estimated 79,000 multi-drug resistant TB patients among the notified cases of pulmonary TB each year, India also has the highest number of multi-drug-resistant (MDR) TB and TB-HIV co-infected cases. (iii) India has the third highest malaria burden in the world and is also one of the 11 countries (the remaining 10 are from sub-Saharan Africa) that bear the highest global burden of malaria. Together, they accounted for the bulk of all malaria cases and deaths, globally, in 2017. Is this a cause to worry? Yes. Should we lose hope? No. For, this would mean leaving the millions affected, both visible and invisible, in the lurch. Women and girls would be the worst-hit considering gender barriers, stigma and discrimination that prevent them from accessing prevention and care services related to TB, HIV and malaria. Besides women, the lives and potential of children, migrants, tribal and slum populations, communities living in geographically difficult areas and vulnerable groups such as people co-infected with TB and HIV, would also be compromised. Now, more than ever, these figures should act as a trigger to power greater commitment and action. It is no rocket science that targeted and enhanced health financing can avert new cases of TB, HIV and malaria and, thus, save millions of lives.

This was reiterated by the 2019 replenishment investment case report by the Global Fund to Fight Aids, Tuberculosis and Malaria (Global Fund). In a recently released summary in Delhi, it underlined the need for $14 billion to get the world back on track to end AIDS, TB and malaria. This investment would help save 16 million lives, cut mortality rate for the three diseases by half and avert 234 million new infections by 2023. A full investment case will be released at the Global Fund’s sixth replenishment preparatory meeting in India in February. In India, investments in TB control received a boost when Prime Minister Modi pledged to eliminate TB by 2025, five years before the 2030 target of meeting Sustainable Development Goal 3 (SDG:3) to ensure healthy lives and promote well-being of all. So, the Government’s domestic funding went up from $110 million (Rs 79 crore) in 2016 to $458 million (Rs 3,320 crore) in 2018. But was this enough? Malaria, on the other hand, hasn’t caught attention to the same extent; although 90 per cent of the Indian population is at risk of malaria infection. Incidentally, people in less developed neighbouring countries like Bangladesh and Nepal face a much lower risk at 11 per cent and 48 per cent respectively. Although the National Strategic Plan for Malaria hopes to end the epidemic by 2027, three years ahead of the global deadline (2030 SDG:3), it also states that it will need $1.518 billion (Rs 10,653.16 crore) for the period between 2017-2022. And these funds will be raised from Government sources, international donors and the corporate sector as part of corporate social responsibility. Will this be possible?

While there has been a 67 per cent decline in HIV incidence in India, less than half the people with HIV are on antiretroviral treatment (ART). This implies that the infection is not under control for many people. A 2018 assessment of the burden of HIV drug resistance mutations in India found that the overall burden of resistance against first-line ART remained steady over a decade. India’s National Strategic Plan for HIV has a budget of $4.715 billion for the period of 2017-2022. But with an estimated 69,000 deaths in 2017 from AIDS-related illnesses and the emergence of 88,000 new infections, is the funding available adequate? It doesn’t seem so with public spending on health still being 1.2 per cent of GDP, significantly lower than required. At the recent Delhi meeting organised by the Global Fund, the Global Fund Advocates Network Asia-Pacific and India Working Group, communities and civil society groups expressed concerns about India not being on track. India must take concrete steps to fully fund the country’s HIV, TB and malaria response, contended Dr Sonal Mehta, IWG member and head of the India HIV/AIDS Alliance. Increased funding should not be a problem considering the statement by Amitabh Kant, the NITI Aayog CEO, that the Indian economy may even exceed the IMF growth forecast of 7.5 per cent. Unfortunately, economic growth does not always ensure or guarantee equitable system responses or equal access to healthcare, or end debilitating out-of-pocket expenditures for the marginalised.

But this should not stop the Government from stepping up its efforts and listening to the voices of survivors and affected populations. If it has the political will to reach out to key and vulnerable populations disproportionately affected by the three diseases, it must find the funds to expand the use of rapid diagnostic tests, provide early treatment for malaria, HIV and TB cases, including rolling out newer TB drugs like Bedaquiline.

(The writer is a senior journalist)