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TB Drugs Shortage: 113 Global Bodies Write to PM Modi, Seek His 'Urgent' Intervention

They urged Modi to undertake emergency procurement and reallocation of drug stocks for patients facing shortages of medicines in the country.

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:

  1. Undertake emergency procurement and reallocation of stocks to DOTS & DOTS Plus centers experiencing stockouts and shortages of anti-TB
  2. Expedite drug procurement, improve inventory management, and strengthen supply chain
  3. Ensure transparency and accountability in the supply chain management
  4. 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
  5. Sufficiently allocate resources at the center and the state level to ensure a consistent supply of TB
  6. Establish a system for monitoring and reporting on drug stock levels to prevent future
  7. 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