India steps up TB fight as fears of drug-resistant strains mount

MUMBAI — The discovery of an almost untreatable form of tuberculosis in India has set off alarm bells around the world and helped spur a dramatic expansion of government efforts to battle the killer lung disease.

For the past decade, a nationwide tuberculosis program involving millions of health workers and volunteers has made slow but significant progress in battling the disease in India and has been hailed as a public-health success story. But any sense of complacency was dispelled in December when a doctor in Mumbai, Zarir Udwadia, discovered a strain of the disease that did not respond to any of the 12 frontline drugs. He declared a handful of patients at his chest clinic in Mumbai to be suffering from “totally drug-resistant TB.”

Some 130 years after the discovery of the tuberculosis bacteria, and more than 60 years after the discovery of antibiotic treatment, “we have managed by a combination of complacency and incompetence to allow this bacillus to mutate into a virtually untreatable form,” he wrote in the journal of the Asian Pacific Society of Respirology.

His findings made national headlines and won him government condemnation for “spreading panic” and “spoiling the country’s reputation.”

The government, however, recently announced a fourfold increase in the budget to fight tuberculosis in its next five-year plan, the expansion of a nationwide network of costly labs capable of detecting drug-resistant strains of the disease, and the first concerted effort to bring on board India’s poorly regulated private health-care sector.

“The government is taking a very ambitious approach of universal access,” said Ashok Kumar, director of the national TB program. “We aim to detect all TB cases as early as possible and see everyone takes their treatment early and completes it. It needs a lot of effort.”

About 2 million Indians have the disease diagnosed every year, and about 1,000 die of tuberculosis every day.

But the highest mortality rates are found within an estimated 100,000 Indians who suffer from “multi-drug-resistant” strains of the disease, so called because patients do not respond to the two most powerful drugs available.

Months of treatment are needed to eradicate tuberculosis from a patient’s system, and failure to complete the course, or take the right drugs, often allows the bacillus to mutate into drug-resistant strains.

Diagnosis of these strains can be done only in sophisticated laboratories, and treatment, at up to $2,000 per person, costs 200 times what it costs for regular patients.

For that reason, the government has until now virtually ignored patients with drug-resistant strains, with potentially disastrous consequences.

“The problem of drug-resistant tuberculosis is one that the authorities have often tended to gloss over because they have always been more focused on dealing with the huge problem of drug-sensitive TB,” Udwadia said. “We have failed this group of patients, the multi-drug-resistant TB patients. We don’t have the funds to diagnose them correctly. Once we’ve diagnosed them, we don’t treat them correctly. And we pass it off as public-health realpolitik.”