dailyO
Politics

Why tuberculosis is still eating into India

Advertisement
Dr Virander S Chauhan
Dr Virander S ChauhanMar 31, 2016 | 15:49

Why tuberculosis is still eating into India

We need to lead the way in R&D for TB and should allocate sufficient resources for the same.

Encouraging research and innovation to eradicate tuberculosis Tuberculosis (TB) remains a major public health challenge for India. Estimates show that 2.2 million new cases of TB occurred in 2014. It is evident from this that our efforts to stem the spread of TB have not delivered desired results. Drug-resistant TB is the emerging new threat and has indicated the need to change our strategy and transform the way TB is diagnosed, treated and prevented.

Advertisement

Research and development is one of the pillars of the WHO's End TB Strategy and will have to play a pivotal role if the goal of a TB-free world by 2050 is to be achieved. Considering the magnitude and changing nature of TB, particularly the emergence of different forms of drug-resistant TB, it is necessary to significantly increase investment in R&D to tackle this old and complex enemy of mankind.

The low spending on TB R&D both globally and in India has hampered effective control of TB. According to a report released by the Treatment Action Group (TAG) and the Stop TB Partnership, globally funding towards TB R&D has stagnated in the past five years. India spent as little as $9 million on TB R&D in 20142. Considering that 220,000 people die of TB1 in India every year, and the fact that drug-resistant TB is posing a major threat to our fight against this disease, there is an urgent need to increase investment in TB R&D.

Priority areas for R&D in TB

The escalation of R&D efforts across the spectrum are necessary - from fundamental research and development of advanced diagnostics, drugs and vaccines, to operational research for the introduction of new technologies and better use of existing tools for improved TB control.

Advertisement

Studying and understanding the changing epidemiology of the TB bacillus; transmission among populations and high-risk groups and the variance of TB in these groups; as well as the social and biological factors leading to higher transmission need to be investigated to develop effective interventions. Epidemiology is also important to assess the efficacy of ongoing interventions in order to improve upon them.

daulati-on-x-ray-tab_033116024220.jpg
Treatment of drug-resistant TB is expensive. (Photo credits: John Schupbach)

Another vital area of interventional research is diagnostics. The age-old sputum smear microscopy, which misses more than half of the cases, is still widely being used for diagnosing TB in India. Newer technologies including cartridge-based nucleic acid amplification test or CB-NAAT (Xpert MTB/Rif) and line probe assay (LPA) can transform TB care in the country, providing accurate and rapid diagnosis of both drug-sensitive and drug-resistant TB. However, the high costs associated with these tests make it difficult to scale-up these advanced diagnostic technologies.

The Indian Council of Medical Research (ICMR) and the department of biotechnology have jointly established a task force to evaluate indigenously developed diagnostics for TB in a time-bound manner. A point-of-care diagnostic tool has been developed by an Indian company and evaluation of the test is underway. Our goal must be to provide affordable, accurate and point-of-care diagnostics that are capable of rapidly screening and diagnosing drug-resistant TB, HIV-associated TB and paediatric TB.

Advertisement

Development of new drugs and drug regimens is another area that deserves urgent and long-term attention. The lengthy drug regimen for drug susceptible TB requires continuous counselling and the lack of treatment adherence have posed as a challenge to TB control programmes worldwide. Furthermore, the treatment of drug-resistant TB is many times more expensive, can take up to two years and has been associated with low treatment success rates.

The launch of Bedaquiline, the anti-TB drug for drug-resistant TB through a conditional access programme holds promise for treating drug-resistant TB patients. However, research should continue and should focus on developing a shorter regimen, which is compatible with antiretroviral therapy (ART), is less toxic, is suitable for children and most importantly is affordable.

Finally, with the rise of drug-resistant TB around the globe, the urgent need to invest and develop a vaccine cannot be overemphasised. Given its strength in vaccine production and scientific ability to carry out vaccine research, India must lead the way in the development of an effective vaccine. Regulatory authorities however must recognise the importance of clinical trials which need to be conducted for the introduction of a possible new vaccine.

Lastly, operational research is necessary to enhance all aspects of TB control and management, including diagnosis, treatment and immunisation against TB and to address the challenges posed by drug resistance and co-morbidities such as HIV infection.

Recognising the criticality of research

India, in the past two decades, has made significant progress and we were successful in achieving the Millennium Development Goal for TB. Policy and technological developments in the past few years in India are encouraging. On World TB Day 2016, the Union minister for health and family welfare, announced the induction of 500 CB-NAAT machines and launched the new MDR-TB drug, Bedaquiline which is expected to significantly enhance our diagnostic and treatment capabilities.

However, the glass seems to be only half full. The current state of TB control demands an increased prioritisation and investment in R&D for TB. With more than one-fourth of the global disease burden, India should lead the way in R&D for TB and should allocate sufficient resources for the same. R&D for TB and health in general can transform public health in India and help the generations to come to lead healthy lives.

Last updated: March 24, 2018 | 12:04
IN THIS STORY
Please log in
I agree with DailyO's privacy policy