Why Does TB Still Kill 2 Indians Every 3 Minutes?

With 1 in 5 global TB patients in India & the rise of drug-resistant strains, are we losing the battle against TB?

India has the highest burden of TB in the world and accounts for around one-fifth of the global incidence. Out of 9.4 million new TB cases globally, 2 million are estimated to have been in India (Photo: Reuters) 

This story from The Quint’s archives has been republished on the occasion of World Tuberculosis Day.

By the time you finish reading this story, somewhere in India, 4 people would’ve lost their lives to tuberculosis (TB).

The disease reflects the silent plague that urban India is waking up to. The ancient scourge tamed by modern drugs has evolved into a new, indestructible disease which kills more than a thousand Indians every day.

The situation is dire: over the next three decades, 75 million people in the world are likely to lose their lives to drug-resistant TB, and by 2050, the infection could cost the global economy as much as $17 trillion.
(Source: World Health Organisation)

An easily treatable, curable disease which was on the verge of decline in the 70s, has metamorphosed into a deadly, drug-resistant killer, which infects more than two million Indians annually. So what went wrong, why haven’t we been able to fight this age-old affliction till now?

Why Has the Government Been Dragging Its Feet On the New TB Drug?

In December 2012, the US Food and Drug Administration approved Sirturo or Bedaquiline, the first drug to fight multi-drug resistant TB in nearly 50 years.

The US FDA and 27 European nations gave a fast track approval to the new highly potent drug because the fight against TB was in desperate need of some new arsenal.

(Photo: The Quint)

However, in India, where the disease by conservative estimates kills a thousand people every day (Source: World Health Organisation), drug resistance is growing at an alarming pace, (Mumbai alone has more than six thousand multi-drug resistant TB cases), the Union Health Ministry approved the ‘miracle drug’ Bedaquiline after three years of it being approved by the US FDA.

Dr Zarir Udwadia of Hinduja Hospital, reasonably one of the top TB specialists in the country, sourced ‘Bedaquiline on compassionate grounds for 14 end-stage TB patients at no cost from its Belgium-based manufacturer in 2014.

Five of the 14 patients lung MDR TB patients, who would’ve otherwise died, ‘responded very well to the drug’ - the rest were in various stages of treatment. The results of these 5 patients were published in the International Journal of Tuberculosis and Lung Disease.

Considering India has the highest burden of TB in the world, were these results not enough proof to the government to cut across red-tapism and approve the much needed effective anti-TB drug three years back?

Ancient Disease, Modern Imperative

In 2011, Dr Zarir Udwadia of Hinduja Hospital, reported in a medical journal that he had four TB patients that were resistant to all types of treatment. In a couple of months, there were 15 such cases (Photo: Hinduja Hospital)

Currently, TB experts in Mumbai see a third of their patients who are incurable with standard medicines. TB is a highly infectious disease and with no system in place for isolating these patients.

Doctors fear one TB patient can infect at least 15-20 others in a year.

So the discovery of an almost untreatable form of TB set off alarm bells around the world.

Though the overall tuberculosis rate has come down in India, it is still a leading cause of death among people between 15 - 45; the most productive age group in any country. And the growing numbers of multi-drug resistant or MDR-TB is a big concern.

India has more than 65,000 registered TB patients, (RNTCP Annual Report 2012) the real figure will be much higher. The treatment therapy of MDR-TB is both extensive and expensive; it involves popping 20 pills and getting daily injections for nearly one to two years.

Diagnosis of these strains can be done only in sophisticated laboratories, and treatment, can cost up to Rs 2 lakh per person, which is 200 times what it costs for regular patients.

As the problem of multi-drug resistant TB grows, so does the waiting lists for the expensive and lengthy courses of treatment (Photo: AP)

According to the Global TB Report 2013, only 65% of the total notified cases of multi-drug resistant TB were put on treatment. TB is an entirely preventable and curable disease. The government claims we have one of the best national TB control programmes in the world. If it is really so, then why is the most dangerous form of drug resistant TB making such bold inroads in the country?

Learning From the South Africa’s TB Detection Model

The economic burden of TB to the Indian economy between 2006 - 2014 is estimated to be a staggering $340 billion (Source: Report by the Joint Monitoring Mission of the RNTCP) (Photo: iStock)

South Africa has the third largest TB epidemic in the world, only behind India and China. And now it has launched a five-year-long campaign to comb through the high risk population and not let a single person go undiagnosed. The aim is, by 2017, nearly 90% of the country would have been screened for the deadly disease.

On the other hand, India’s TB programme, riddled with corruption and budget cuts, is almost derailing.

A report by the Joint Monitoring Mission of the RNTCP admits that in the last two years, more than a million people living with tuberculosis in the country have gone undiagnosed or unreported. And coupled with the fact that 10% TB drugs in the country are fake or counterfeit, there has been an acute shortage of drugs for MDR-TB since 2013, India might just be losing all the progress it has made to curb this deadly disease.

TB already causes an estimated 100 million workdays loss due to illness. The country will also incur a loss of nearly US$ 3 billion in indirect costs and US$ 300 million in direct costs (Source: RNTCP).

Rising cases of drug resistant TB will only exaggerate this problem. India can no longer afford to be indifferent to the rise of drug-resistant tuberculosis. The disease does not only flourish in faraway slums, it is haunting urban India at a potentially great cost.