The TB battle has just begun

From totally drug resistant tuberculosis (TDR-TB) to extremely drug resistant TB (XXDR-TB) to extensively drug resistant TB (XDR-TB), Mumbai has been walloped through half of the TB spectrum in under two weeks.

While the union government asserts that it is XDR-TB, Hinduja Hospital claims it is TDR-TB. One has authority, the other claims authoritative evidence. The tricky part is the difficulty in defining TDR. To begin with, the term doesn’t exist. It was coined not by the WHO but by researchers in 2009 who discovered a cohort of 15 patients in Iran did not respond to any TB treatment.

This is where the problem lies. Tuberculosis not being a dominant concern in the developed world, there is no established protocol to prove TDR-TB. While the methodology for other drug-resistant strains has been studied and standardised, it is not so for TDR-TB. TDR should ideally apply to cases where no drug works, not just the first line of treatment for TB (which would make them multi-drug resistant) or even the second line (which would make them XDR).

A bigger surprise than the discovery of a stubborn TB bacterial strain is the government’s unusually assertive and proactive stand. Hinduja Hospital’s formidable team, which has been researching TB for 15 years, can intimidate the best government officers. Incidentally, it reported the first cases of XDR tuberculosis in India as well.

So what gave the government the confidence to dig in its heels? Perhaps the fact that it has as the head of Indian Council of Medical Research a scientist known to be a giant in tuberculosis research? Dr VM Katoch, director general, ICMR, is known for his extensive research in TB, leprosy and HIV.

The controversy has come as a blessing for patients with drug-resistant TB. The government’s DOTS Plus programme was limited to drug-resistant TB patients in public hospitals but now, it has committed free drugs to every such patient. What’s more, patients wary of the government centres can continue to consult private doctors, which was not permitted earlier.

Another silver lining is the government plan to notify drug-resistant TB cases, which will streamline data on the subject. Unlike the West, which documents every single case, we had no such requirement till now.

The Centre should now get its act together. We still don’t keep a count of the number of cases. For a country where TB is endemic, the disease is curiously not notifiable. Hospitals have no place to send samples for testing, which is half the reason they set up the tests in their labs. Mumbai is hugely affected because of its size and congestion but the lone TB hospital at Sewri is on a suicide mission.

There is vast room for correction. The work has only begun.