Indo-US trade war is a new challenge to India’s TB elimination program

Recent years have seen significant geopolitical shifts that have impacted not only international relations but have also had repercussions on the daily lives of common people. The election of Donald Trump and subsequent rise in nationalism in the USA has led to a trade war between the former and, China and India.

An ardent believer of social-media politics, President Trump’s tweet about the rise in tariffs by India on American products heightened tensions around the politics of trade between the countries. The withdrawal of the Generalized System of Preferences, designed to promote economic growth in the developing world by providing preferential duty-free entry for up to 4,800 products, signified the start of the trade war between the countries, to which India retaliated by increasing import duties on 28 products which include food-items, and most importantly diagnostic reagents.

Houston: Prime Minister Narendra Modi and President Donald Trump shake hands after introductions during the "Howdi Modi" event Sunday, Sept. 22, 2019, at NRG Stadium in Houston. Image credit: AP/PTI Photo

From a public health standpoint though, the imminent rise in the cost of diagnostic tests is a matter of concern, especially as India is gearing up to eliminate infectious diseases like tuberculosis (TB).

Affordable diagnosis is the first step toward elimination

TB continues to be a major public health challenge for India. Each year, we estimate that around 28 lakh new TB cases emerge in India, which represents over one-fourth of the global burden of the disease. Moreover, the emergence of drug-resistant forms of the disease has posed a considerable challenge as correct diagnosis (to understand resistance against drugs) at the very start, has become more important than ever.

Fortunately, we have new and rapid WHO-approved diagnostic tests that have been available in India for the past six years, allowing faster detection, thereby increasing the likelihood of patients receiving timely and accurate treatment. However, these diagnostic tests are out of reach for the majority of the Indian population who seek care in the private sector, with a single test costing thousands of rupees in private labs. This amount is considerably high for the poor and vulnerable who have higher chances of contracting the disease.

Since 2013, private laboratories have come together to form networks to bring down the costs of these tests known for their precision, for instance, the molecular diagnostic tests used to detect resistance against first-line drugs. The Initiative for Promoting Affordable and Quality TB Tests (IPAQT) network has since been successful in negotiating directly with the manufacturers, thereby bringing down the costs in IPAQT empanelled labs by 50 percent (₹ 2,200), as compared to labs not part of the scheme which charges anywhere between ₹4,000–₹5,000. However, with the increase in import duty, these tests will cost even higher than before.

TB now a political priority

For the past few years, the profile of TB has changed dramatically, and the disease’s elimination today has been prioritized by the highest levels of the government, particularly by Prime Minister Narendra Modi. Backing his commitment, the government has launched a new plan to eliminate the disease by 2025, five years ahead of the Sustainable Development Goal target. One of the most important strategies being proposed is the engagement of the private sector health care providers, who cater to a majority (50-70 percent) of TB patients in the country.

A man suffering form tuberculosis. Image credit: Reuters

The government has also partnered with a donor agency to roll out private sector engagement programs across the country, under the Joint Effort for Eliminating TB (JEET) initiative. These programs have been based on pilots that were deployed in three cities in India – Mumbai, Patna and Mehsana. The pilots involved creating a network of sensitized service providers in the private sector to strengthen their capacity to serve patients better. By engaging a host of private providers including chemists, diagnostic labs, and formal and informal providers, the initiative was highly successful in improving the quality of care in the private sector.

However, instead of supplying services through neighborhood private laboratories and chemists, the JEET model relies heavily on the public sector infrastructure for drugs and diagnostics, making service delivery a potential challenge. This may cause delays in diagnosis and eventually treatment.

Our humble suggestion to the government is to make use of private diagnostic labs and chemists, to not only avoid delays in diagnosis but also improve access to these critical services for patients. Along with a reduction or a complete waiver of import duties, these small course corrections can have a transformative impact on the lives of patients.

Dr Navin Dang is the Founder and Managing Director, Dr Dang’s Lab