Editorial: TB or not TB

Published in The Hindu on April 24, 2012

With tuberculosis killing two people every three minutes and the number of people with drug-resistant TB increasing manifold every passing day, even the reports of the first few patients being detected with “totally drug-resistant” tuberculosis — i.e., resistant to all first- and second-line TB drugs — in Mumbai in January did little to spur the government into acting decisively. On the contrary, as in the case of the NDM-1 superbug case, its initial reaction was on expected lines — denying and rubbishing the find. That the World Health Organisation is yet to formally recognise the TDR-TB term cannot be cited as a reason for inaction. TDR-TB was first reported from Italy in 2007 and Iran in 2009. Worse still, the government has further exposed its lack of ingenuity and leadership with its meek response: launching a website next month for “monitoring and tracking” patients with drug-resistant TB, and using the data from the DOTS (Directly Observed Treatment Short course) programme for creating “awareness.” This move is nothing but a reflection of its unwillingness to tackle a potentially dangerous public health problem. The government is fully aware that the DOTS programme does not cover all TB patients in the country. With a large number of them, including those with drug resistance, turning to private practitioners, even the most robust tracking procedure will never be able to solve the problem. If the government’s focussed TB programme is miserably equipped to handle drug-resistant TB, the state of private health care to tackle such cases is appalling. As on 2010, there were nearly 300 million TB-infected patients, and as per 2006 data, more than 110,000 had multidrug-resistant TB.

The first and most important step for tackling the disease is to make every medical practitioner accountable and treat every patient correctly. This can be achieved only by making TB a notifiable disease. The only reason the government has not done this is that the actual number of cases will be known. But hiding the truth is no way of solving the problem; instead it will only compound the crisis. Educating doctors about correct drug regimens and testing protocols should be done simultaneously. Increasing the number of drug-resistance testing centres and the use of new rapid drug susceptibility technology must become a routine for every patient who fails to respond to first-line drugs. These measures will go a long way in preventing the number of people developing resistance to existing drugs. Such bold initiatives are required and should be implemented swiftly if the government is serious about preventing a crisis from getting out of control.