Imagine this: you are a poor Indian who lives in a rural area with very little access to the healthcare system. Over the last few weeks, you are suffering from low fever and intermittent coughing. After a couple of visits to the local doctor, he suspects that you have tuberculosis (TB). He asks you to do a few tests and then treats you with anti-TB drugs. You start taking them and after some time you stop because either you are feeling better or you cannot afford them. Maybe, after a few days you will again visit a doctor and do the same cycle again. You will spend some more money but might not be necessarily cured. This story is repeated hundred times every hour in may parts of the country. .
All this because of TB — a communicable disease, caused by the TB bacilli, which unlike other major killer diseases like malaria and HIV/AIDS, spreads through air — and if it is left untreated, an active TB patient can infect 10-15 people every year.
That's not all. The TB bacillus is adaptable and has managed to overcome all that has been developed to combat it. The spread of drug resistant strains has been a major cause of concern; untreated cases of Multi-Drug Resistance (MDR) have also led to the evolution of Extremely Drug Resistant (XDR) strains.
A recent report from the Mumbai-based Hinduja Hospital, describing the presence of XXDR-TB that stands for extensively drug-resistant TB as against XDR and MDR versions of drug resistance, are alarming. These investigators have used the term, Totally Drug Resistant TB (TDR-TB) for these cases.
The spread of such drug resistant strains will not only be a nightmare for doctors but will also be a complex issue for the TB patient management system. Unfortunately, such a situation is building up in India and if it not taken seriously and urgently, it may create a major health catastrophe.
So what can be done to counter it proactively? One of the major challenges is diagnosing the disease: the tests are either outdated or inaccurate. The most commonly used — sputum smear microscopy — is 125 years old and detects only half the cases. The serological tests are also inaccurate. Yet more than $15 million is spent on these tests in India each year. Additionally, tests such as Interferon Gamma Release Assay are also being widely misused by the private sector for diagnosis of active TB when they are intended for detecting latent TB. An immediate measure would be to consider better methods of detection.
All drug-resistance in TB is man-made, caused by the inappropriate use of anti-TB drugs. With a large population accessing the private sector for medical services, the large-scale distribution of anti-TB drugs has become rampant. Private providers use non-standard regimens, prescribe non-quality assured drugs and provide treatment without ensuring patient adherence through supportive supervision. We need tighter regulation.
The ministry of health has achieved remarkable results in the control and treatment of TB. The challenges, however, lie in the private sector. Many doctors in the private sector do not know the disease and its treatment regimen well. Perhaps it will be a good idea to encourage private sector practitioners to send TB patients to the government-run programmes.
But despite the presence of externally drug resistant TB, the situation is not irreparable. India should ban the sero-diagnostic tests and encourage implementation of newer alternative technologies. A concerted effort must be made to develop new drugs against TB by encouraging public-private partnerships, involving basic researchers and the pharma industry. All this could lead to the discovery of new methods to combat this dreadful disease.
Finally, we must not forget that TB is a curable disease. When it claims its next victim, it will be because we have not been able to tackle it from the start.
VS Chauhan is director, International Centre for Genetic Engineering and Biotechnology The views expressed by the author are personal.