Even as health experts have warned that the detection of a new form of tuberculosis resistant to all known medication could confront India with a major public health disaster, the government has defended itself by arguing that the Mumbai-based hospital which discovered the threat was not accredited to carry out tests for the disease.
In a statement issued on Tuesday, the Ministry of Health and Family Welfare said the Hinduja Hospital, where doctors reported detecting the new tuberculosis bacillus last week, was not officially accredited to test for the efficacy of modern, second-line drugs used to fight the disease.
The hospital, it said, was only accredited to test for first-line drugs. It also said the World Health Organisation (WHO) had not advocated testing for drug resistance beyond a form of tuberculosis known as XDR-TB, or extensively drug-resistant tuberculosis.
“For now,” the statement said, “these cases [in Mumbai] are defined as extensively drug-resistant tuberculosis, according to WHO definitions, and can be managed by national XDR-TB treatment guidelines.” The term, totally drug-resistant tuberculosis, is neither recognised by the WHO nor by the Revised National Tuberculosis Control Programme, it said.
The statement added that the government had sent a team of doctors to Mumbai to ascertain the facts about the new kind of tuberculosis, but did not say when their findings might become available or how it had determined the new disease was treatable with existing medications.
Medecins Sans Frontiers, the international health organisation, described the findings as a “public health emergency,” and a stark warning of what could lie ahead if India does not “wise up” to the tuberculosis threat. Leena Menghnaey, an MSF spokesperson, said the core problem was that “access to TB drugs in India is not regulated and anyone can get hold of them at any doses for any length of time.”
Failure to complete the full course of treatment with appropriate drugs has led to the emergence of tuberculosis variants that are resistant to the best available medication. Researchers at Hinduja Hospital, where four cases of tuberculosis totally resistant to drugs, said these patients had previously only been treated in the private sector.
“This is probably only the tip of the iceberg in India,” Ms. Menghnaey said, calling on the government to take measures to prevent the casual over-the-counter sale of antibiotics.
About 1,000 people die of tuberculosis in the country every day and 40 per cent of the population believed to be infected may be afflicted with the full-fledged disease at some point the immunity of an individual is low. The bacteria settles down in the human body and has a long gestation period running into several years or even decades. Irregular drug dosage can result in the bacterial mutating into forms resistant to treatment. Though there is a protocol to be followed for the treatment of drug-resistant tuberculosis, erroneous use by unqualified doctors has led to a spiralling problem.
India's official treatment strategy covers about 75 per cent of the patient load at present, and has shown positive results with the number of deaths falling drastically to 2.8 lakh per year from 5 lakh in just about 10 years. However, the problem occurs when the public health system fails to deliver due to lack of medicines or human resources, either forcing people to drop out from the treatment or opt for private doctors who do not stick to the protocols due to the free availability of tuberculosis drugs in the market or even prescribe wrong combinations for quicker treatment which can be disastrous.
Multi-drug resistant TB is becoming more prevalent, because more people drop out as the treatment is spread over two years, and 100 times more expensive.
The photograph accompanying this article has been removed to ensure patient privacy