From the time of its discovery in 1882 by Robert Koch, to the first World TB Day a century later, the tubercle bacillus has remained one step ahead of mankind.
Today, India has a high TB burden, with one in every four new cases of TB being from the country. Drug resistant strains have added another dimension to the disease as well. As someone on the forefront of the TB epidemic in India, Dr Zarir Udwadia, a consultant chest physician and his team at Mumbai’s Hinduja Hospital, were the first to describe Totally Drug Resistant TB (TDR-TB) from India, in October 2011. The knee-jerk reactions to this news was typical: ignore the problem, sweep it under the carpet, dispute the findings etc.
But Dr Udwadia’s team’s work was published and discussed both globally and within the country, building up to a new sense of urgency. Today, India’s national TB control plan, the Revised National Tuberculosis Control Programme (RNTCP) may be hailed as a success story but policy makers are trying to bridge the gaps with better implementation. More pharma companies are researching new drugs (See story: The TB armamentarium, page 11 of this issue) as they see increasing market potential but we also have irresponsible prescription patterns and patient non-compliance which is taking us down the TDR route. On the diagnosis and testing side, we do have new tools but we need stronger policy intervention to move beyond current screening practices (See story: TB diagnosis: Beyond culture, page 42).
The battle against TB and more so its Multi Drug Resistant (MDR) avataar, involves orchestrating the efforts of multiple stakeholders: doctors (both in the private and public space), pharma and diagnostic kit manufacturing companies, global agencies like WHO and MSF; as well as health activists and the media. The last two groups have emerged as the crucial last-mile crusaders, as both have a powerful impact on changing the mindset of the patient. (See story: Taming MDR TB, page 30)
Unfortunately, today it seems to be a case of too many cooks. Each stakeholder strives to work independently and therefore is often at cross purposes with other players. The patient has faded into the background noise, when in reality, s/he is the most important piece of the puzzle. Let’s hope that RNTCP’s revised goal of ‘universal access’ for quality diagnosis and treatment for all TB patients in the community will be able to cover more of the country’s population. India has finally been declared polio-free; we need to fight TB with the same zest.
Viveka Roychowdhury
Editor
