And now it’s TDR TB! Why are we not able to get our act together?
Over the past week or so, two significant things have happened. India has been declared polio-free as a whole year 
has passed without a single case of polio being reported. The WHO has lauded India’s efforts in this direction. Calling it “India’s greatest public health achievement”, the WHO said the number of polio-endemic countries – those which have never stopped indigenous wild poliovirus transmission – could soon be reduced to a historical low of three: Afghanistan, Nigeria and Pakistan. Admirable achievement there.
On the flip side, the media has gone to town with news about India being only the second country in the world to report cases of totally drug resistant (TDR) TB after Iran. 12 cases in Mumbai, 2 in Bangalore and suspicions that this is only the tip of the iceberg. So we have regular, MDR, XDR and now, TDR TB to deal with. There is considerable debate, denial and discussion on whether this new form can be termed TDR TB. As per a report in Indian Express, “The doctors from Hinduja have unnecessarily raised a panic alarm. The term TDR is not recognised by the WHO or the Revised National Tuberculosis Control Programme (RNTCP). As of now, they are only slotted as XDR-TB cases,” said an official from the Directorate of Health Services.
While the debate goes on, a thought continues to trouble me. Are we getting stuck on terminology? It makes little difference what we call the different forms of TB which are among us. What matters is that people are dying – 1000 per day. These are precious lives that need not be lost. What was it that worked for polio which has not worked for TB. Why does it continue to be so serious and so persistent an issue? The answers are possibly simple. The Pulse Polio programme used every means possible, showed consistent commitment to its eradication and did not spare the expenses involved. There was political will, there was optimum level stakeholder involvement and the results are there for all to see. If we had heeded on time, the fact TB was slowly entrenching itself in our population and acquiring new strains and strengthening its hold; if we had reacted strongly enough to nip it in the bud, we would be in happier circumstances. We have been caught sleeping. When do we get our act together for TB? When do we dig in our heels and say it is not acceptable for us to lose 1000 precious lives every day? Call it any name but banish it.
Bharathi Ghanashyam
Not just a question of terminology, agree – I invite your readers to check out this very interesting discussion on this: http://www.ghdonline.org/drtb/discussion/cases-of-totally-resistant-tb-in-india/
Sophie Beauvais
January 18, 2012 at 9:22 pm
Terminology shouldn’t be the focal point, but it certainly is important in understanding how to approach dealing with this “new” form of TB, whether it’s totally, or just extremely, drug-resistant. Technically, it is XDR-TB, because we eventually will find a combination of antibiotics to treat it. Currently, it’s TDR-TB simply because we don’t know how to cure it…yet. To the most important point, the reason that TB is still around and polio is not is a matter of fundraising. Rotary International raised 260 million USD to eliminate polio. The TB community hasn’t banded together and coordinated its efforts to the extent that the polio community did. For that to happen, the WHO and the Stop TB Partnership will need to get on the same page in terms of policy and objectives.
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