Mumbai: India has miles to go before it successfully tackles tuberculosis, Stephen Lewis, co-founder and co-director of international advocacy organisation AIDS-Free World, has said. Mr. Lewis, who was on a fact-finding tour of New Delhi and Mumbai earlier this month, has come out with ‘TB in India: Rhetoric vs. Reality’, a report that says it’s too early to shower accolades on the Indian government, and nothing in the last several years lends confidence.
Mr. Lewis claims in his report that many in India and other countries feel India has dramatically turned the corner on TB, with the government calling for its elimination by 2025, charting out a National Strategic Plan, rolling out the diagnostic tool GeneXpert, going in for a broader rollout of two new drugs, bedaquiline and delamanid, and the Prime Minister too adding his voice to the crescendo of endorsement.
“I want, with all my heart, to believe that this picture of achievement is real. But I am seized by incredulity. There are too many factors that give me pause,” Mr. Lewis said. He spent four days in New Delhi and three in Mumbai with colleague Georgia White, visiting public and private sector facilities, senior bureaucrats, the World Health Organisation, USAID, the Clinton Health Access Initiative, Gates and the Médecins Sans Frontières in both cities.
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Mr. Lewis, who has been Canada’s Ambassador to the United Nations, says the goal of eliminating TB by 2025 is aspirational mythology. “During our trip, we barely heard reference to latent TB, although a third of the population has it, and it could, with hallucinatory implications, lead to active TB. The social determinants of health lie in tatters: homelessness, overcrowding, poor nutrition, food insecurity and excruciating poverty, taken together, constitute a death knell for public health.”
Referring to a visit to a paediatric hospital in New Delhi, he said, “Toddlers were lying three and four to a bed. Dr. Singh, the lead doctor, was explaining to us that there was no way to isolate children with TB, nor was there focused paediatric care for children in specialised Multi Drug Resistant-TB settings. They were breaking pills for adults into small fragments, hoping for successful treatment of childhood TB.”
Mr. Lewis also talks about the 18-year-old girl from Patna, who had to go to court to get access to the highly-controlled anti-TB drug bedaquiline, and how she has not shown any signs of the disease after bedaquiline. “It is, however, incomparably sad to report that her lungs are so compromised that survival will be a constant struggle. It should never have come to that for the girl: she stands as a medical billboard for the failures of the Indian health system in addressing tuberculosis.”
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Dr. Zarir Udwadia, a Mumbai-based chest physician, said Mr. Lewis eloquently exposes the hypocrisy and doublespeak still surrounding TB in some government circles. “As he points out, unless we build bridges between public and private sectors, the problem will worsen.”
Dr. Sunil Kharpade, who heads the Central TB Division under the Union Ministry of Health and Family Welfare in New Delhi, said he isn’t aware of Mr. Lewis, his visit or his statement. “Many such people keep visiting. They are mainly activists. India’s TB programme is doing very well and has received global recognition.”