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Should TB be treated as a national health emergency against which a war needs to be waged jointly by Government, doctors and society?

• The new variant of TB, multidrug-resistant TB (MDR TB), is as deadly and painful as cancer. It means death for many Indians but worse, unlike cancer, it spreads through the air. An infectious person can thus spread the disease wherever he or she goes—at home, in the neighbourhood and at the workplace. Yet, we do not have a national health emergency. Since TB has been with us since decades and is curable, we have taken its treatment for granted and are largely unaware of the new deadly form the TB bacilli has taken.
• In some patients, the TB bacilli is resistant not just to the first line of wonder drugs—Rifampicin and Isoniazid—but also even second-line drugs, causing extremely or extensively drug-resistant TB (XDR TB). The pattern is getting worse, with some patients declared resistant to all the 12 or 13 known drugs to treat TB, thus having totally drug-resistant TB (TDR TB). While normal TB takes about six months to cure, MDR TB and XDR TB takes two or more years to cure. The bacilli spreads with lightning speed, attacking body vitals, sometimes even making painful surgeries necessary for survival. The side effects of the drugs are a nightmare with many patients preferring death instead. The cost of treatment is anything between Rs 3 lakh to Rs 20 lakh and more. If MDR TB turns into an epidemic, it could drain our national resources and ruin families and communities.
• Every MDR TB patient, if undiagnosed and untreated, can spread MDR TB to at least 10 other people. If the undiagnosed and untreated patient lives in a crowded area or travels in a crowded train, one can imagine what is happening. According to the World Health Organization's Global Tuberculosis Report 2013, India has the highest number of MDR TB patients in the world. We are almost sitting on a time bomb because of which all our development plans could go awry.
• MDR TB has been caused because we failed to manage normal TB. This mismanagement has happened both in the private sector and in the government's Revised National Tuberculosis Control Programme (RNTCP).
• The government will have to make fundamental changes in the design of the present RNTCP which could be causing a large number of MDR TB. Today, the RNTCP is based on an alternate day regimen, i.e., patients are administered drugs every alternate day. On the ground, what actually happens is that for various reasons, this leads to gaps and goes into creating MDR TB. Throughout the world, a daily regimen of drugs is the norm as this ensures better compliance of treatment. We need to make this change at the earliest. Besides, we need regulation of the private sector since quacks and even private doctors often contribute to creating drug resistant TB through wrong diagnosis and treatment.
• The RNTCP must make diagnosis available to detect drug resistance at the earliest, preferably before any treatment is started. Today, with drug resistance TB, it is not enough to know if a person has infectious TB but to also know which of the drugs a person is resistant to. This means setting up a huge network of free diagnostic centres throughout the country.
• Since TB is directly related to malnutrition, the battle against TB should be part of the larger battle against malnutrition. A healthy and balanced diet is the best drug against TB. People of all classes in India, especially TB patients, must have access to high-nutrient food.
• Finally all efforts must be made by the government in providing our research bodies with grants and other support to discover miracle drugs against MDR TB.
• MDR TB can only be vanquished if government, health workers and civil society are all involved in this war. We need hundreds of motivated DOTS workers to administer the drugs. We also need health workers actively seeking TB patients. We need to counsel patients to complete their treatment.
• This is a war where half measures will not do. This is a war in which we will either all survive or perish together. The government has to drastically increase the health budget to fight this war. Just as India vanquished polio by waging a war against it, we must do the same for TB.