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 MeetIndia’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-110011Hon. Mansukh Mandaviya,Minister for Health and Family Welfare & Chair of the Stop TB Partnership Board Room No. 348, ‘A’ Wing,Nirman Bhavan, New Delhi-110011New 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 lineFurthermore, 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-TBExpedite drug procurement, improve inventory management, and strengthen supply chainEnsure transparency and accountability in the supply chain managementUrgently 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 medicinesSufficiently allocate resources at the center and the state level to ensure a consistent supply of TBEstablish a system for monitoring and reporting on drug stock levels to prevent futureUrgently convene a meeting with civil society and community members fromThe 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 SignatoriesOrganizationCountry1Advocates of Hope for Community (AHFCO)Kenya2AMERICAS TB COALITIONUnited States3Andhra Pradesh Drug Users forumIndia4ARASAUganda5Association des Jeunes Juristes du NigerNiger6Association For Promotion Sustainable DevelopmentIndia7Bengal Network of People Living with HIV/AIDSIndia8Beyond Initiative for Social Concern (BISC)Kenya9Blossom TrustIndia10Busia Health and Social Justice CenterKenya11Chaitanya NetworkIndia12CHEBKenya13Chichetekelo Outreach PartnersZambia14Club des Amis DamienDRC15Coalition of Women Living with HIV and AIDSMalawi16COLTMR CICôte d’Ivoire17Comité de Dialogue et de Cohabitation PacifiqueChad18Community And Family Aid FoundationGhana19Council of People of Living with HIVAids of KeralaIndia20Dekoma Medical ClinicKenya21DEVI SansthanIndia22Dignity Education Vision InternationalIndia23Disability Peoples ForumUganda24Dr. K Alexander Medicine Professional CorporationCanada25EkaitaKenya26Emmanuel Hospital Association (EHA)India27Empower IndiaIndia28EX TB GambiaGambia29For Impacts in Social HealthCameroon30Fountain of Hope CBOKenya31Fundamental Human Rights & Rural Development AssociationPakistan32GFANFiji33GFAN APSri Lanka34Ghana National TB Voice NetworkGhana35Giving Tuesday RDCDRC36Global Alliance for Human RightsIndia37Global Coalition of TB AdvocatesGlobal38Global TB CaucusGlobal 39Gujarat State Network of People Living With HIV/AIDSIndia40Happy to Help FoundationIndia41HopesTelangana42ICHANGECôte d’Ivoire43Integrity Social Justice CentreKenya44International Treatment Preparedness Coalition (ITPC)Global45ITPC-LATCALatinoamérica & Caribbean /Guatemala46ITPC-South AsiaIndia47INTILISHUzbekistan48JAPETI (Jaringan Peduli TBC Indonesi/Indonesia TB Care Network)Indonesia49KHANACambodia50Kwanhliziyonye Resource Care CentreSouth Africa51Light Youth Group CBOKenya52Machakos Main HIV AIDS groupKenya53Matahari Global SolutionsUnited Kingdom54Meghalaya State Network Of Positive PeopleIndia55Mentari Sehat IndonesiaIndonesia56MisbahIndia57Moldova National Association of Tuberculosis Patients “SMIT”(Society of Moldova against Tuberculosis)Republic of Moldova58MSNP+India59Mumbai District Tuberculosis Control SocietyIndia60Mzilikazi Miners Exminers AssociationsNamibia61NADP+India62NADP+ AhmednagarIndia63National Ex-miners and Allied Workers Association of ZambiaZambia64National Tuberculosis Coalition of America, Inc.United States65NCPIIndia66Nelson Mandela TB HIV Information CBOKenya67NephakKenya68Network of TB ChampionsKenya69Network of TB ChampionsMombasa70NivaranaIndia73NRPS+ DLNIndia74NTBCKenya75NTP+ CSC VihaanIndia76Pamoja TB groupKenya77Paneer HIV Positive Women NetworkIndia78Penabulu FoundationIndonesia79PERDHAKIIndonesia80PKNI (Indonesia Network of People Who Use Drugs)Indonesia81POP TB IndonesiaIndonesia82Rainbow TB Forum NetworkIndia 83Rangoonwala Foundation (India) TrustIndia84SAF-TESOUganda85Sahara CFRCARIndia86Samburu Positive Living NetworkKenya87Samprity Aid FoundationBangladesh88Sankalp Rehabilitation TrustIndia89Sarathi TrustIndia90Sikkim Drugs’ Users ForumIndia91Smart Widows Support System (SWISS CBO)Kenya92SPARSHANepal93Stop TB CanadaCanada94Stop TB KenyaKenya95Stop TB Partnership Board Member CommunitiesGlobal96Stop TB USAUnited States97SuhagiIndia98Sun-Saharan Access to Pharmaceutical Therapeutics, Diagnosticsand Medicines (SAPAM)South Africa99Support to Health NGOAzerbaijan100TB Europe CoalitionUnited Kingdom101TB Free Foundation of NamibiaNamibia102TB Mukt VahiniIndia103TB People UgandaUganda104TEJ networkIndia105The Delhi Network of Positive PeopleIndia106The Humsafar TrustIndia107The Tuberculosis Association of India (TAI)India108Touched by TBIndia109Treatment Action GroupUnited States110Tweet FoundationIndia111United Nations World Food ProgrammeIndia112Vidhayak Trust, HEaL InstituteIndia113We Are TBUnited States