India: Tobacco control is key to eliminating tuberculosis by 2025

March 29, 2021

Par: National Committee Against Smoking

Dernière mise à jour: March 29, 2021

Temps de lecture: 6 minutes

March 24 was World Tuberculosis Day, a disease endemic in India with over 27% of the world's tuberculosis cases occurring in the country, according to the Global Tuberculosis Report 2019With over 260 million smokers, India also has more than a quarter of the world's tobacco consumers.

As the World Health Organization (WHO) aims to end the tuberculosis epidemic by 2030[1], the Indian government has set a target of eliminating tuberculosis by 2025[2]But the risk of tuberculosis is closely linked to other factors such as poverty, malnutrition and tobacco use.

According to the WHO, around a quarter of people worldwide are infected with the Koch bacillus, which causes tuberculosis.[3]This bacillus can remain in a latent state, or multiply and result in a disease, tuberculosis. Tobacco use not only promotes this transition from the latent state to tuberculosis but also increases the risk of recurrence and impairs the response to treatment of the disease. Worldwide, 26 % of tuberculosis deaths are attributable to tobacco. Before COVID-19, tuberculosis killed more people worldwide than any other infectious disease.

The double burden of smoking and tuberculosis in India

In 2019, 10 million people developed tuberculosis and 1.4 million died from the disease worldwide. With nearly 2.6 million people developing tuberculosis each year, India is the country most affected by the disease, accounting for more than a quarter of the global incidence.[4]Every year, more than 400,000 people die from this infectious disease in the country.[5] and 38% of these deaths are due to tobacco. Although tobacco consumption has declined in recent years, nearly 29% (over 260 million) adults in India are regular users, and this number includes at least 625,000 children aged 10 to 14. Tobacco causes 1.2 million premature deaths in the country[6].

India is also one of the countries with the highest incidence of multidrug-resistant tuberculosis (MDR-TB), meaning the disease is resistant to key treatments, making it the most difficult and expensive to treat. Reducing tobacco use to help prevent and control tuberculosis—including MDR-TB—is critical to saving lives and limiting costs.[7].

Integrating tobacco control into the fight against tuberculosis

Recently, the Indian government proposed amendments to address shortcomings in the Cigarettes and Other Tobacco Products Act (COTPA). If passed, the bill would extend the ban on the sale of tobacco products to those under 21 and strengthen penalties for violating this ban. Similarly, penalties would be strengthened for violations of the ban on all direct and indirect advertising of tobacco products on the internet and social media. Regarding smoke-free spaces, the provision for smoking rooms in restaurants and hotels would be removed.[8]

The adoption of this bill would be a step in the right direction to address the country's interlinked tobacco and tuberculosis crises. Experts say, however, that additional measures to reduce smoking are needed. Indeed, the single-unit sale of cigarettes and bidis remains the norm in India, increasing access to inexpensive products for younger people. Plain packaging for tobacco products, which plays a crucial role in improving the visibility and effectiveness of health warnings and reducing the product's appeal, is not included in the new bill. Furthermore, the implementation of the provisions of Article 5.3 of the WHO Framework Convention, concerning the protection of public policies with regard to the commercial interests of the tobacco industry remains, according to them, generally deficient[9].

The organization Vital Strategies also highlights the need to reach the public with stronger messages about the relationship between smoking (active and passive) and tuberculosis[10]To mark Tuberculosis Day, Vital Strategies worked with the government to launch a national media campaign highlighting the links between smoking and tuberculosis. The campaign highlighted how smoking cigarettes or bidis, as well as exposure to secondhand smoke, increases the risk of contracting and dying from the disease.