“Doctor, you cured me of tuberculosis 50 years ago. But now, why can’t you be certain of curing my son,” Gokul asked me. I advised him to go to a government hospital where the youngster would get appropriate treatment and ₹500 a month during the course. He shook his head disapprovingly and insisted on private treatment.
When he was a patient, TB bacilli were vulnerable to drugs. But with inadequate and irregular treatment over decades, the bacilli gained resistance to them.
In those good old days, multi-drug-resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR-TB) and the almost incurable totally drug-resistant tuberculosis (TDR-TB) were unheard-of. I wrote in the columns of The Hindu of April 28, 1977 that “ …development of drug resistance, which is a result of inadequate and irregular treatment mostly, has far-reaching implications and if unchecked would make tuberculosis totally unmanageable by the present methods in course of time, whatever be the means. Irregular and inadequate treatment keeps the patient often alive, suffering and infective to disseminate drug-resistant organisms into the environment…”
I find that there is less guarantee of a cure now than a few decades ago, notwithstanding the availability of more drugs. There were tools, but we didn’t use them properly. And now it seems that TB has become insurmountable and invincible, notwithstanding the introduction of drugs such as Bedaquiline, Linezolid and Pretomanid.
TB is killing more people than ever before in history — 1,000 people every day in India, at present. This chronic mortality does not become news, whereas one case of COVID-19 grabs the headlines.
The Global Tuberculosis Report, 2019 of the World Health Organization says India has the highest number of TB and drug-resistant TB cases in the world. Officials may claim a declining trend, but Paula I. Fujiwara, Scientific Director of the International Union Against Tuberculosis and Lung Diseases, says: “Let’s be honest — TB is still not falling fast enough in India, progress is still too slow to meet the targets … and if we don’t end TB in India, we can’t hope to end it globally.” Going through the India TB Report 2018: Annual Status Report, one gains the impression that there is political will and a strong strategy to reach the goal of ending TB by 2025, in line with the National Health Policy, 2017.
Rhetoric and reality
On World TB Day on March 24, we mourn the thousand deaths every day while going through the annual rituals of rallies, speeches and seminars. Hackneyed gestures and lax efforts are commonplace. One who follows up these acts can visualise a great scenario of farcical dimensions. The grand pronouncements and the rhetoric may never meet the reality. Why all this annual hype ... singing the same chorus in a different style? The statistics rolled out must be taken with a pinch of salt as the infrastructure is plagued by a lack of genuine reporting systems.
TB has been made a “notifiable disease” for better follow-up and management. Pan-India engagement with the private sector to close the enormous gaps across the patient-care cascade in private medical care has been initiated. We should hope and wish that this strategy would eliminate TB from India by 2025. Let’s do a review that year against the backdrop of a “$5 trillion economy”. And let’s wish Gokul’s son a speedy recovery.
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