Persistent shortages of anti-tuberculosis medicines in government clinics threaten to raise the risk of treatment failure, fuel drug resistance, and thwart India’s plan to “eliminate” TB by 2025, doctors and patients’ groups have said in fresh complaints to the Centre.

Public health experts and patients’ groups in letters to the Prime Minister’s Office and the Union health ministry earlier this week have expressed concern that the shortages of anti-TB medicines have hit patients receiving treatment in government TB clinics in several states.

The patients’ groups who had complained about shortages of second-line anti-TB drugs used for drug-resistant TB last August have now cited shortages of fixed-dose combinations of first-line TB drugs that are given to the vast majority of TB patients.

“We are deeply disturbed that India is experiencing stock-outs of critically required drugs to treat people with TB,” a consortium of patients’ rights groups, including the Jan Swasthya Abhiyan, and TB survivors wrote in a letter sent on Friday to Prime Minister Narendra Modi.

The letter has cited shortages of fixed-dose combinations of rifampicin, isoniazid, pyrazinamide, and ethambutol — four drugs that almost all patients with drug-sensitive TB need to take for two months before continuing treatment with a combination of two drugs.

“An inadequate and poorly administered treatment regimen facilitates drug-resistant strains,” the consortium said in the letter, underlining concerns that patients who experience interruptions in TB treatment face the risk of developing drug-resistant TB. Such patients could also continue to spread the infection to their close contacts, adding to India’s burden of TB and hampering TB control efforts. The shortages “threaten to undo gains made by the TB control programme,” the letter also said.

The Modi government had in 2018 announced a plan to eliminate TB by 2025, five years ahead of the 2030 global target set by the World Health Organisation. Over the past five years, the Union health ministry has scaled up TB diagnostic and treatment services, among other initiatives such as nutrition support for TB patients to achieve the elimination goal.

Sections of health experts who doubt that India will be able to eliminate TB next year say persistent stock-outs of anti-TB drugs will pose additional challenges to the elimination plan.

“The current stock-outs appear to be unprecedented,” T. Sundararaman, a community medicine specialist and former executive director of the National Health Systems Resource Centre, a health ministry division engaged in assessing and planning for healthcare resources.

Sundararman and Yogesh Jain, a physician and public health expert in Chattisgarh, had written to the Union health secretary earlier this week about what they described as a “precarious situation” emerging from the stockouts. They said personal observations and information from members of the public and healthcare provider community have indicated drug shortages in Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra and Rajasthan.

“As a measure of coping, many centres are using paediatric formulations which are in stock and supplementing individual drugs or reducing the number of days for which doses are issued at each visit,” their letter said. “We have received oral reports of many (patients) coming for their monthly medication but having to return empty-handed. The situation with regard to medicines for drug-resistant TB is said to be even worse.”