Indians have not been untouched by the epidemics and pandemics the world has seen over the past 30 years. India is better placed today to tackle and counter pandemics such as Covid-19. We had our share of failures and learning over decades while managing pandemics like cholera, plague, influenza, polio, SARS, Japanese Encephalitis, Chikungunya, H1N1 and Nipah.
In all these decades, more than 30 new infectious agents or pathogens have been detected worldwide. Around 60% of these were found to have zoonotic origin. Covid-19 has resulted in an unimaginable situation with lockdowns and movement restrictions being imposed in many countries.
Apart from this threat at hand, there are many other infectious diseases that continue to claim lives in India, such as malaria and tuberculosis, which have a high mortality rate associated with them. As per WHO, in 2018 India accounted for 27% of TB population across the world. A majority amongst this number is the adult population but a significant portion of children also suffer from pulmonary TB. Tuberculosis is a multi-faceted challenge.
The current government has set a deadline of 2025 to eradicate TB from India. Far-fetched but this deadline has led to multiple innovations that can help us overcome challenges associated with TB. Not only is the country home to the largest TB population and associated deaths, but also faces significant challenges panning from developing an accurate base of TB patients, keeping the affected population on the medication regime, affordability, as well as accessibility.
A targeted approach to identify the population affected from TB remains the biggest hurdle. The aspect demands to methodically identify individuals who are at risk for new infection as well as individuals at increased risk for reactivation due to associated high-risk conditions. The Indian population is not proactively surfacing for a check-up due to resources, stigma, consequential treatment cost et al which needs a comprehensive approach altogether. Identifying this missing TB population through a well-framed testing infrastructure is half battle won! The steps taken to overcome initial stigma and inertia in case of Covid-19 through large mass communication channels can be replicated to apply for TB.
The public health ecosystem has taken into account infrastructural, economical and socio-political approaches developed by the world’s leading forces assigned to overcome the challenge. One model that India can use from Covid-19 pandemic is to tackle the eminent problem of deploying a fine TB testing mechanism and infrastructure to progress and address TB testing roadblocks in India. Despite hurdles, key pieces of the necessary data infrastructure for mass TB surveillance and management can be extracted from Covid-19 model and utilised for collecting data at scale, albeit with gaps, through labs, public and local health agencies.
Once this is deployed, the other giant problem is better and effective drugs that can help people living with MDR and XDR TB. In all these years, USFDA has approved only three drugs that can help in managing TB well including Bedaquiline, Linezolid and now Pretomanid which is yet to be launched in the country. Genomics has emerged as a next-gen diagnostics arena which is boosting drug and vaccine development basis a relatively new-found scientific basis. In TB specifically, the country saw two big advances last year that could augment the way drugs are developed for the Indian population. One was SPIT-SEQ that sequences the entire genomic make-up of the Mycobacterium Tuberculosis (Mtb) which provides intelligence as to which drug will work on the bacteria and the second is Genexpert machine that establishes in a couple of hours whether the patient has resistance to a select list of drugs. When SPIT SEQ was originally launched in Aug-2019, it was a research use only (RUO) test with validation studies underway. As a result of successful validation results, the study was published in the International Journal of Tuberculosis and hence the test is now available to be used in a clinical set-up.
The Covid-19 environment saw multiple schools of thoughts-- one spoke of advantages of BCG vaccine, the other of using anti-malaria drug or even anti-arthritis drug. It will be smart to leverage the scaled-up learnings from this outbreak to manage other public health issues the country needs to defeat.
(The writer is the CEO, MedGenome Labs)