$~26 * IN THE HIGH COURT OF DELHI AT NEW DELHI Date of decision: 25^th APRIL, 2023 IN THE MATTER OF:

+ W.P.(C) 4008/2022 RAMAN KAKAR ..... Petitioner Through: Petitioner in – person.

versus UNION OF INDIA THROUGH SECRETARY & ORS.

..... Respondents Through: Mr. Kirtiman Singh, CGSC with Ms.

Vidhi Jain, Advocate for R-1 and R-2.

CORAM:

HON'BLE THE CHIEF JUSTICE HON'BLE MR. JUSTICE SUBRAMONIUM PRASAD JUDGMENT(ORAL)

1. The instant Public Interest Litigation has been filed for issuance of an appropriate writ, order or direction to quash circular bearing D.O.No. 28015/27/2012 –TB (Part II) dated 18.12.2018, issued by Respondent No.2 herein, which, according to the Petitioner herein, discards Streptomycin Injection, which is used in curing category-II Tuberculosis (TB) Patients. It is the submission of the Petitioner that the Government has not given adequate attention towards the cure of TB which is a poor man’s disease. It is stated that India accounts for about 27 lakh TB patients out of which 22 lakh patients are fresh/new cases who suffered TB for the first time and they are prescribed a ‘milder’ therapy (called Category I), consisting of 4 oral Signature Not Verified Digitally Signed W.P.(C) 4008/2022 Page 1 of 15 drugs - Ethambutol, Isoniazide, Rifampicin , Pyrazinamide. It is stated that the remaining five Lakh patients are persons who have contracted the disease for the second or the third time and they are called category-II patients. It is stated that category – II patients require a more aggressive treatment which includes Streptomycin Injection in addition to four abovementioned drugs.

2. It is stated that the Petitioner is a qualified Allopathic Doctor and holds a Diploma in TB and Chest Diseases. It is stated that the Petitioner has already filed four PILs which all pertains to treatment of TB patients. It is submitted in the Petition that Ministry of Health and Family Welfare, Government of India, has issued a circular dated 18.12.2018 by which the current regimen for category II patients will no longer be used and all category II patients will be initiated on standard first line anti TB regimen as prescribed for new TB patients. Relevant portion of the said circular reads as under:

“ 8. The States may ensure availability of injection Streptomycin for all patients being initiated till date. In case, the stocks of Streptomycin are fully consumed in the entire State, the States may procure only limited stock (5ml along with syringe and needle and water for injection) to complete treatment of patients initiated on previous injectable containing regimen.”

3. The Petitioner places reliance on Order dated 23.01.2017, passed by the Apex Court in Writ Petition (Civil) No.604/2016 titled as Dr. Raman Kakar, Government Medical Officer, Revised National TB Control Program of India v. Union of India and Anr., wherein the Supreme Court had directed that new Fixed-Dose Combination (FDC) drugs for daily regimen for Signature Not Verified Digitally Signed W.P.(C) 4008/2022 Page 2 of 15 treating TB patients will be administered to new patients after the expiry of nine months. The Petitioner submits that the present circular is contrary to the judgment passed by the Apex Court wherein the Apex Court had striked down the order passed by the Government of India which stated that “…the earlier regimen whereby treatment was administered thrice in a week, will not be continued under any circumstances after expiry of a period of nine months from today”. The Apex Court had granted nine months to the Additional DDG, Directorate General of Health Services, Ministry of Health and Family Welfare, for the nation-wide transition to the new regimen. According to the Petitioner, the Apex Court has put an end to the earlier treatment replacing it by an effective daily dose model, which, according to the Petitioner, would include Streptomycin Injection. The Petitioner has, therefore, filed the instant Petition.

4. Notice in the present petition was issued on 27