New Delhi: As many as 113 civil society organisations and 776 individuals from across the world have addressed a letter to Prime Minister Narendra Modi and health minister Manshukh Mandaviya seeking urgent intervention in the issue of shortage of drugs for TB patients.
The drug-resistant TB patients in India (such as TB patients on whom the first line of TB drugs don’t work and require advanced treatment) have been facing drug shortages for several months now.
The Wire recently published a piece capturing the voices of family members of TB patients, some civil society groups, state TB officers, and multilateral organisations like the WHO. Although these stakeholders expressed grave concern over the issue, the Indian government denied any such problem two days after the publication.
Also read: Unprecedented TB Drugs Stock-Out in India: Union Health Minister Skips UN High-Level Meet
India’s health minister also skipped the UN high-level meeting on TB amidst this shortage. The meeting took place in New York on September 22. Now, these TB advocacy groups have written the letter from New York. The groups and individuals come from Kenya, the United States, the United Kingdom, Zambia, Malawi, Uganda, Canada, Ghana, Cameroon, Indonesia, South Africa, India, and several other countries.
India has the highest TB burden in the world, and therefore, disease prevalence, or any hindrance in disease treatment in India, would be a key factor in the global elimination of TB. The WHO aims to eliminate TB globally by 2030 while the Indian Prime Minister Modi has set the target for 2025 for the country.
The full letter and list of signatories is reproduced below:
§
To:
Hon. Prime Minster Narendra Modi 152, South Block,
Raisina Hill,
New Delhi-110011
Hon. Mansukh Mandaviya,
Minister for Health and Family Welfare & Chair of the Stop TB Partnership Board Room No. 348, ‘A’ Wing,
Nirman Bhavan, New Delhi-110011
New York, September 22, 2023: People with TB, treatment providers, medical practitioners, survivor activists, civil society organizations, academics, writers and health journalists urge Indian Prime Minister, Narendra Modi and Health Minister Mansukh Mandaviya to take immediate steps to urgently address the issues of drug stock outs in India’s TB programme.
Even as the UN High Level Meeting on TB signed on a political declaration today, the country having the highest burden of TB and drug-resistant TB (DR-TB), India, is now reporting chronic stockouts of anti-TB medicines. The frequent stockouts of anti-TB drugs threaten to undo gains made by India’s TB programme and also make the ambitious targets India has set for herself – to eliminate TB by 2025, five years before the SDG goal – unattainable. Uninterrupted supply of medicines is the first step to preventing drug resistance. The current stockouts are forcing people to go without treatment at catastrophic cost. Rajjab, a driver working with a private carpool company in Mumbai recently explained that “now, neither the government is able to provide me with the medicines, nor are they available at the medical stores” and he asks “if my wife dies, who would be held responsible for this crime?” Those who can find and buy the drugs from the private sector, are feeling added out-of-pocket expenditure and the substantial financial burden on their families.
At the facility level, the second line drug supply too has been erratic and there are reports that there is no supply of drugs for both multi drug and extensively drug resistant TB (XDR-TB) and states have been asked to procure the same locally. Drug stock outs at the state level may lead to further TB drug resistance in people who are forced to interrupt their treatment, which also means that their treatment may stop working for them.
Since June 2023, there have been regular reports of stockouts of drugs used to treat TB and MDR-TB in several DOTS & DOTS-Plus Centres across the country. The persistent shortages have affected both first- and second-line TB drugs, including pediatric formulations.
A list of drugs that have been out of stock, since June, include:
Moxifloxacin (Lfx), Cycloserine (Cs), Linezolid, Clofazamine, Pyridoxine, Delamanid FGD-1st line
Furthermore, India has lagged behind most other high burden countries in implementing the new BPaL/M treatment that is recommended by WHO as the preferred regimen for MDR-TB and shorter TB preventive therapy with 3HP.
As a concerned group of TB activists from around the world, we call on the Government of India to:
- Undertake emergency procurement and reallocation of stocks to DOTS & DOTS Plus centers experiencing stockouts and shortages of anti-TB
- Expedite drug procurement, improve inventory management, and strengthen supply chain
- Ensure transparency and accountability in the supply chain management
- Urgently roll out the shorter, simpler, more effective, new treatment BPaL/M. BPaL/M will not only improve patient outcomes but reduce risk of stockouts due to fewer medicines
- Sufficiently allocate resources at the center and the state level to ensure a consistent supply of TB
- Establish a system for monitoring and reporting on drug stock levels to prevent future
- Urgently convene a meeting with civil society and community members from
The global and local tuberculosis community is willing and eager to collaborate with the government and relevant stakeholders to find sustainable long-term solutions. The undersigned leaders of health, human rights organizations are deeply concerned about the worsening situation in India.
Organizational Signatories
| Organization | Country | |
| 1 | Advocates of Hope for Community (AHFCO) | Kenya |
| 2 | AMERICAS TB COALITION | United States |
| 3 | Andhra Pradesh Drug Users forum | India |
| 4 | ARASA | Uganda |
| 5 | Association des Jeunes Juristes du Niger | Niger |
| 6 | Association For Promotion Sustainable Development | India |
| 7 | Bengal Network of People Living with HIV/AIDS | India |
| 8 | Beyond Initiative for Social Concern (BISC) | Kenya |
| 9 | Blossom Trust | India |
| 10 | Busia Health and Social Justice Center | Kenya |
| 11 | Chaitanya Network | India |
| 12 | CHEB | Kenya |
| 13 | Chichetekelo Outreach Partners | Zambia |
| 14 | Club des Amis Damien | DRC |
| 15 | Coalition of Women Living with HIV and AIDS | Malawi |
| 16 | COLTMR CI | Côte d’Ivoire |
| 17 | Comité de Dialogue et de Cohabitation Pacifique | Chad |
| 18 | Community And Family Aid Foundation | Ghana |
| 19 | Council of People of Living with HIVAids of Kerala | India |
| 20 | Dekoma Medical Clinic | Kenya |
| 21 | DEVI Sansthan | India |
| 22 | Dignity Education Vision International | India |
| 23 | Disability Peoples Forum | Uganda |
| 24 | Dr. K Alexander Medicine Professional Corporation | Canada |
| 25 | Ekaita | Kenya |
| 26 | Emmanuel Hospital Association (EHA) | India |
| 27 | Empower India | India |
| 28 | EX TB Gambia | Gambia |
| 29 | For Impacts in Social Health | Cameroon |
| 30 | Fountain of Hope CBO | Kenya |
| 31 | Fundamental Human Rights & Rural Development Association | Pakistan |
| 32 | GFAN | Fiji |
| 33 | GFAN AP | Sri Lanka |
| 34 | Ghana National TB Voice Network | Ghana |
| 35 | Giving Tuesday RDC | DRC |
| 36 | Global Alliance for Human Rights | India |
| 37 | Global Coalition of TB Advocates | Global |
| 38 | Global TB Caucus | Global |
| 39 | Gujarat State Network of People Living With HIV/AIDS | India |
| 40 | Happy to Help Foundation | India |
| 41 | Hopes | Telangana |
| 42 | ICHANGE | Côte d’Ivoire |
| 43 | Integrity Social Justice Centre | Kenya |
| 44 | International Treatment Preparedness Coalition (ITPC) | Global |
| 45 | ITPC-LATCA | Latinoamérica & Caribbean /
Guatemala |
| 46 | ITPC-South Asia | India |
| 47 | INTILISH | Uzbekistan |
| 48 | JAPETI (Jaringan Peduli TBC Indonesi/Indonesia TB Care Network) | Indonesia |
| 49 | KHANA | Cambodia |
| 50 | Kwanhliziyonye Resource Care Centre | South Africa |
| 51 | Light Youth Group CBO | Kenya |
| 52 | Machakos Main HIV AIDS group | Kenya |
| 53 | Matahari Global Solutions | United Kingdom |
| 54 | Meghalaya State Network Of Positive People | India |
| 55 | Mentari Sehat Indonesia | Indonesia |
| 56 | Misbah | India |
| 57 | Moldova National Association of Tuberculosis Patients “SMIT”
(Society of Moldova against Tuberculosis) |
Republic of Moldova |
| 58 | MSNP+ | India |
| 59 | Mumbai District Tuberculosis Control Society | India |
| 60 | Mzilikazi Miners Exminers Associations | Namibia |
| 61 | NADP+ | India |
| 62 | NADP+ Ahmednagar | India |
| 63 | National Ex-miners and Allied Workers Association of Zambia | Zambia |
| 64 | National Tuberculosis Coalition of America, Inc. | United States |
| 65 | NCPI | India |
| 66 | Nelson Mandela TB HIV Information CBO | Kenya |
| 67 | Nephak | Kenya |
| 68 | Network of TB Champions | Kenya |
| 69 | Network of TB Champions | Mombasa |
| 70 | Nivarana | India |
| 73 | NRPS+ DLN | India |
| 74 | NTBC | Kenya |
| 75 | NTP+ CSC Vihaan | India |
| 76 | Pamoja TB group | Kenya |
| 77 | Paneer HIV Positive Women Network | India |
| 78 | Penabulu Foundation | Indonesia |
| 79 | PERDHAKI | Indonesia |
| 80 | PKNI (Indonesia Network of People Who Use Drugs) | Indonesia |
| 81 | POP TB Indonesia | Indonesia |
| 82 | Rainbow TB Forum Network | India |
| 83 | Rangoonwala Foundation (India) Trust | India |
| 84 | SAF-TESO | Uganda |
| 85 | Sahara CFRCAR | India |
| 86 | Samburu Positive Living Network | Kenya |
| 87 | Samprity Aid Foundation | Bangladesh |
| 88 | Sankalp Rehabilitation Trust | India |
| 89 | Sarathi Trust | India |
| 90 | Sikkim Drugs’ Users Forum | India |
| 91 | Smart Widows Support System (SWISS CBO) | Kenya |
| 92 | SPARSHA | Nepal |
| 93 | Stop TB Canada | Canada |
| 94 | Stop TB Kenya | Kenya |
| 95 | Stop TB Partnership Board Member Communities | Global |
| 96 | Stop TB USA | United States |
| 97 | Suhagi | India |
| 98 | Sun-Saharan Access to Pharmaceutical Therapeutics, Diagnostics
and Medicines (SAPAM) |
South Africa |
| 99 | Support to Health NGO | Azerbaijan |
| 100 | TB Europe Coalition | United Kingdom |
| 101 | TB Free Foundation of Namibia | Namibia |
| 102 | TB Mukt Vahini | India |
| 103 | TB People Uganda | Uganda |
| 104 | TEJ network | India |
| 105 | The Delhi Network of Positive People | India |
| 106 | The Humsafar Trust | India |
| 107 | The Tuberculosis Association of India (TAI) | India |
| 108 | Touched by TB | India |
| 109 | Treatment Action Group | United States |
| 110 | Tweet Foundation | India |
| 111 | United Nations World Food Programme | India |
| 112 | Vidhayak Trust, HEaL Institute | India |
| 113 | We Are TB | United States |