Address TB drug shortage, Mumbai activists urge union health minister

An uninterrupted supply of TB medicines is a key element of the National Tuberculosis Elimination Programme. Representation Pic

Tuberculosis (TB) survivors and health activists from Mumbai's Jan Swasthya Andolan have written to Union Health Minister Mansukh Mandaviya, seeking his urgent intervention in the shortage of essential TB medicines at DOTS and DOTS Plus centres across the country.

The letter, authored by HIV/TB survivor and activist Ganesh Acharya and co-signed by Brinelle D'souza, Co-Convenor of Jan Swasthya Abhiyan (Mumbai), requested the Ministry of Health and Family Welfare to undertake emergency procurement and reallocation of anti-TB drugs at DOTS and DOTS Plus centres.

Among other things, health activists urged the ministry to establish a "stock monitoring committee", comprising officials of India's National Tuberculosis Elimination Programme (NTEP), supply chain experts, and TB community representatives. "This committee should meet monthly to prevent and address shortages and stockouts of TB drugs in a timely, transparent, and accountable manner," the letter reads.

Earlier, mid-day spoke to several TB patients and doctors in Mumbai to understand how the shortages since June have impacted treatment. This newspaper also highlighted the shortage of crucial TB medicines across the country and the fact that instead of the Centre providing them directly, the states have been tasked with procurement of the drugs.

Decentralisation woes

"Decentralised procurement of this kind is particularly challenging for states with a smaller number of TB-affected people, limiting their negotiating power on quantity, price, and delivery timelines. Limited budgets may also lead to states procuring drugs that are not quality-assured, thereby compromising people's treatment outcomes," the letter reads.

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In addition to mid-day's revelation of shortages of medicines like Cycloserine, Linezolid, and Clofazamine, the letter also highlights a scarcity of other essential anti-TB medicines such as Moxifloxacin, Pyridoxine, and Delamanid. Over the past few days and at the time of this report, mid-day attempted to reach out to the Central TB Division's Dr. Alok Mathur, who is in charge of procurement and supply of TB medicines. However, there was no response from him.

The NTEP recognises an uninterrupted DOTS programme as the primary step in preventing the spread of drug-resistant TB. The DOTS-Plus guidelines emphasise an uninterrupted supply of second-line TB drugs. "An inadequate and poorly administered treatment regimen facilitates drug-resistant strains. The most severe impact of these persistent stockouts of anti-TB drugs is on people currently undergoing treatment," states the letter, which is also addressed to Central TB Division head Dr. Rajendra Joshi. Shortages also inhibit India's goal of becoming TB-free by 2025.

Interruptions in treatment put patients with drug-resistant TB at risk of developing further resistance to medications. It is worth noting that drug-resistant TB is transmissible and the lack of access to medicines increases the risk of transmission to a larger community. Furthermore, health activists emphasised that access to some of these drugs in the private sector is also extremely challenging due to limited supply or lack of availability.

2025
Year by which India aims to become TB-free