Raising the need to develop a new vaccine for tuberculosis, Soumya Swaminathan, former chief scientist at the World Health Organisation (WHO), said India, considering its accelerated timeline for TB elimination than the rest of the world, should be in the lead, and scientists and researchers around the country as well as globally should come together to develop a better vaccine.
“We need a new vaccine, better diagnostics and point of care. Why can’t we have a rapid test for TB like we have for COVID-19?....The technology, science, researchers and companies are there. I think what is needed is a call, a mission to come together,” she said, delivering an oration on “Towards Health Equity - a vision for India”, organised to mark the 25th year commemoration of REACH, a NGO working in the area of TB, on Friday.
For diseases, which have good vaccines available, there is hope that they could be controlled or even eliminated at some point, she said, adding: “There has to be a global call. We now have genetic sequencing done everywhere. There are new platforms - the mRNA platform, viral vector, DNA, protein subunit and the traditional vaccines. All of these platforms were used for COVID-19. We should be testing all of them for TB also.”
Noting that developing a TB vaccine was not going to be easy, she said with the right investment and collaboration, it was possible to make progress. Dr. Swaminathan earlier pointed out that the BCG vaccine was 100 years old.
She said that findings of the National TB prevalence survey - conducted by Indian Council of Medical Research and WHO - were worrying. Considering the country’s goal of achieving TB elimination by 2025, the prevalence was 300 per 100,000, bacteriologically confirmed TB cases, she said. “The prevalence was the same when I joined the Tuberculosis Research Centre as a young doctor in 1991. That has to make us think why we are not making a dent though there are national programmes and global funding. Still our prevalence is very high, and Tamil Nadu’s prevalence is 322 per 100,000 for all forms of TB. The death rate is around 4%-5%, while it is 6% in T.N. Diabetes, alcohol and TB are very high in T.N. compared to the national average,” she said.
In India, the main risk factor for TB is undernutrition. “This is why we find TB incidence is higher in lower economic groups, especially in tribal and remote rural areas and in the urban poor. This becomes an issue of equity. How do we address this? Why is the TB rate four times more among this group?” she observed.
She called for a science-based approach to be applied to TB control now. “Doing more of the same thing is probably not going to help. We need to brainstorm on where the challenges and gaps are,” she said.
Outlining learnings from the prevalence survey, she said, “First, can we start a massive active case finding programme using X-ray. Second, we need to use more molecular tests. On average, in India, only 20% of patients have access to the first molecular test. During COVID-19, we have done 900 million tests. If we could have scaled up so fast for COVID-19 as there are laboratories everywhere that can do not only PCR but also sequencing, why can’t we use these facilities for TB,” she said.
Health Minister Ma. Subramanian, who released REACH’s new logo and charter on the occasion, said that 96,500 new TB patients were identified in the State last year.
Nalini Krishnan, executive secretary and co-founder, REACH, said TB was still a challenge. “But with new strategies and ‘END TB’ goal, recognition and inclusion of the community, we think this is the best time in the history of TB control to redirect, change our outlook and achieve our common goal of creating a TB-free world,” she said. N. Ram, Director, The Hindu Publishing Group, introduced Dr. Swaminathan. Ramya Ananthakrishnan, director, REACH, Rajivan Krishnaswamy, president, REACH executive committee and Sheela Augustine, deputy director, REACH spoke.