All out effort vital to control TB

On World Tuberculosis Day this year, I kept asking myself, ‘to be or not to be?’ We are all too familiar with this quote from Shakespeare’s play Hamlet

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Probably, I should not have begun on such a low note. But then, all through the recent weeks, listening to one expert after another, deliberating on the global burden of disease and the alarming situation in tuberculosis (TB) control, especially the multi-drug resistant (MDR) ones in India, I could not stop myself from feeling low.

More so, because I have seen this disease from close quarters for a long time – starting from the mid-1990s, while working on my doctoral thesis in Anthropology, and pretty consistently thereafter in my professional life as a public health researcher. It’s rather depressing to see us failing in the battle against TB.

India is a country of 1.3 billion people and a large number of people still remain undiagnosed for TB only to succumb to death rather than getting cured. Stopping TB transmission is important and for which early detection is the key. Our current efforts to find and treat latent TB infection and TB disease are not sufficient. Misdiagnosis of TB still exists and healthcare professionals often do not ‘think TB’, increasing the burden for MDR-TB.

In addition, TB diagnosis and treatment are negatively affected by medical pluralism and doctor shopping behaviour that exist in our health systems. We cannot be complacent to accept these facts at this time of science and technology when we are able to send the Mangalyaan to Mars and engage in innovative research engagements in our laboratories for newer antibiotics and vaccines.

‘Unite to End TB’

As a country, we are the first ones to think about a national TB control programme, way ahead in time compared to other developed nations. We have a health system in place and its networks in the communities.

We have a huge number of trained doctors and healthcare workers, both in public and private sectors. We have borne the brunt of this disease, unlike any other country. And here at this point, joining all these dots, we can come up with a robust plan for TB control and tame this menace.

Each year, we commemorate the World TB Day on March 24 which recognises Dr Robert Koch’s discovery of Mycobacterium tuberculosis in 1882. This year’s World Tuberculosis Day theme is “Unite to End TB” and quite literally we need to unite.

We need to unite practitioners with the researchers, we need to unite the patients with the healthcare providers, we need to unite the policy makers with the implementers, and most importantly, we need to unite the funders with the aspects of TB control.

What we have for long understood is that health is, quite literally, wealth and that every life thus saved and cured contributes to economic growth and development. Thus, a stronger and much larger investment is needed to accrue that wealth.

Recently, I met with Prof Barry Bloom, former dean of Harvard C T Chan School of Public health, and in his words, this is ‘the most opportune time for India’ to do something for TB control and show it to the world. This could not have been done in Africa for there is a lack of infrastructure, but India has an existing healthcare infrastructure.

The current head of India’s Medical Research is a TB enthusiast and she has an incredible track record of leading important and impactful TB research in the country, so there’s this indomitable leadership available for us. Our prime minister vows to ‘Make in India’ and this creates room for making a newer line of antibiotics to able to deal with multi-drug resistance in TB.

And like never before, there are a large number of research institutes and organisations which work in the community and together they are willing to battle it out against TB.
And indeed, this is our opportunity to ‘unite’ and make our stand very clear for TB control in the country and in the world at large.

At this juncture, it is only logical to think together and deliver together for TB control in unison. Thus, it makes more sense to discuss TB and bring it to the forefront in our daily discourses, in public forums, in research collaborations, in policy discussions, and unite all mediums. Let us all unite for one common cause, let us ‘Make India TB-free’.

(The writer is an Associate Professor at Indian Institute of Public Health-Delhi, Public Health Foundation of India)