“Science is always wrong. It never solves a problem without creating ten more.”
-- George Bernard Shaw
Another mantra to bid TB adieu
Writer : T. Rama Prasad
Blog : https://drtramaprasad.blogspot.com
Email ID : drtramaprasad@gmail.com
Date : September 7, 2024
For more on this subject, go to : https://drtramaprasad.blogspot.com/2017/04/tb-and-covid.html and https://drtramaprasad.blogspot.com
Vega, a medical student, showed me the front page news report in THE HINDU of September 7, 2024 with details of a new treatment regimen for ‘Multidrug-resistant Tuberculosis (MDR-TB)’ and asked whether tuberculosis (TB) can be eliminated from India by 2025 as envisaged, with the new treatment. I said that we would be lucky if we don’t end up creating TB bacilli resistant to the new drugs (Bedaquiline, Pretomanid, Linezolid and Moxifloxacin of BPaLM regimen) also, let alone eliminating TB. Outcome of TB treatment is not like mathematics. Half-a-century ago, when ‘effective’ drugs were introduced, everyone thought that TB would be wiped out soon, and now with the introduction of a new regimen for MDR-TB, we seem to be assured of eliminating even MDR-TB soon.
It’s the natural aversion to take medicines for a long time of six months or more that makes TB invincible and insurmountable, not the dearth of effective drugs.
Drug resistance
MDR-TB remains a public health crisis and a health security threat even to people in well-developed countries. It arises out of irregular, inadequate and inefficient treatment. More than 40 years ago, I predicted and 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 … "
Ground realities
The prophecy is vindicated by the Global Tuberculosis Report, 2019 of the WHO which said that India has the highest number of TB and drug-resistant TB cases in the world. It is perhaps poetic that an estimated 10.6 million people fell ill with TB in 2021, an increase of 4.5% from 2020, and 1.6 million people died in the year from TB worldwide. Globally, TB is the first leading infectious killer – a ‘durable’ killer, compared to the ‘short-time’ killer, COVID-19.
TB is killing more people than ever before in history – around 1,000 people every day in India alone, at present, and 3,500 people worldwide. And, 30,000 people get infected with TB bacilli every day across the globe. It is claimed that there had been a reduction of incidence and mortality by about 17% from 2015 to 2022 in India, but the purported decline does not change the mentioned figures significantly. Statistics of the World Health Organization (WHO) for India for 2021 gave an estimated incidence of 2,590,000 TB cases.
This chronic mortality does not become news, whereas a death due to COVID-19 grabbed the headlines. When I entered the TB field half-a-century ago, I thought that it would be hard to find a case of TB in 2020s to show to medical students for teaching purpose. Vega, the medical student, is lucky to have a lot of TB cases to study !
DREAM or DOABLE ?
A commitment was pronounced at the United Nation’s high-level meeting on TB in 2018 to end the TB epidemic by 2030 which is one of the health targets of the ‘United Nations Sustainable Development Goals (SDGs)’.
Going through the ‘India TB Report 2018 : Annual Status Report’, one gains the impression that there is a political will and a strong strategy to reach the goal of ending TB in India, much earlier, by 2025, in line with theNational Health Policy, 2017. With the will and commitment, reiterated by the prime minister often, India will be free from TB by 2025 -- a dream or doable ?
The COVID-19 pandemic has complicated the scenario of TB globally. The WHO and the researchers are of the view that the recent worsening of the TB epidemic globally is likely to be associated with the pandemic. The causes may be varied: decreased attention to TB owing to the enormous focus on COVID-19; potential biological effects of the interaction between the two diseases –- a ‘Cursed Duet’. Studies revealed that people with ‘old healed lesions of TB’ who get infected with the ‘Covid virus’ suffer more from lung function impairment and poor quality of life. The risk of death due to TB is 1 to 3 times higher in COVID-19 patients. The two diseases may be mutually aggravating. A clearer picture would emerge only after the completion of the ongoing global study on TB and COVID-19 patients, coordinated by the Global Tuberculosis Network (GTN) and supported by the WHO. Ironically, TB has remained insurmountable over a long period of time though it is preventable and curable, while COVID-19 is exiting after a short spell of three years though its prevention and cure are not yet clear. As it did with almost everything else, COVID-19 may upset the plans and targets set for elimination of TB.
Dr. T. Rama Prasad
Left to right:
Dr. T. Rama Prasad, Former Medical Superintendent (Special) of RT Sanatorium & Perundurai Medical College, (2) Dr. S. Prabhakar, Erode District Collector, (3) Thiru Thoppu N.D. Venkatachalam, Ex Minister & Perundurai MLA, (4) Dr. S. Geethalakshmi, Vice-Chancellor of the Tamil Nadu Dr. MGR Medical University, (5) Prof. Dr. M. Rajendran, Dean of the IRT Perundurai Medical College, (6) Thiru V. Shanmugan, Chairman of The Nandha Educational Trust.
Some writings, presentations, papers and comments related to TUBERCULOSIS by Dr. T. Rama Prasad:
1. https://www.thehindu.com/opinion/open-page/a-bad-patch/article31069356.ece
2. Five years Plans and TB Control Programme (Special Article) -
The Hindu, Vol.101, No. 275, November 24,1978
3. How effective is the TB control programme ? (Special Article) -
The Hindu, Vol.100, No. 274, p.8, 1977.
4. https://drtramaprasad.blogspot.com/2017/04/yellow-nail syndrome_28.html
5. https://drtramaprasad.blogspot.com/2017/04/tuberculosis-in-india_29.html
6. Rama Prasad, T., COVID and Tuberculosis. The Antiseptic, 2021 December;
Vol. 118; No.12; P: 11-17; Indexed in IndMED -- www.antiseptic.in
7. https://drtramaprasad.blogspot.com/2017/04/tb-and-covid.html
8. Drug Resistance in Tuberculosis - Journal of the Indian Medical
Association, Vol. 64, pp. 264-267, 1975.
9. Childhood Tuberculosis - Part I - The Antiseptic, Vol. 76, pp. 449-504,1979
10. Childhood Tuberculosis - Part II - The Antiseptic, Vol. 76. pp. 567-574, 1979
11. Short-course Chemotherapy - The recent Advances in the Treatment
of Respiratory Tuberculosis - Current Medical Practice, Vol.24,
pp. 41-46, 1980.
12. Drugs in the treatment of Tuberculosis - The Antiseptic,
Vol. 75, p.678, 1978
13. Chemotherapy of Tuberculosis - The Antiseptic, Vol. 76, p.248, 1979.
14. Streptomycin in Tuberculosis - The Antiseptic, Vol. 76, p.516, 1979.
15. National Tuberculosis Control Programme - views presented,
on invitation by theTuberculosis Association of India, at the 32nd
National Conference on Tuberculosis and Chest Diseases, 1977.
16. Correlation between Geomagnetic Activity and Haemoptysis -
paper presented at the II Tamil Nadu State Conference on Tuberculosis
& Chest Diseases, 1980.
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