Follow Us:

‘TB is a disease of poverty’

Ajita Singh |

Director General of Indian Council of Medical Research (ICMR) Soumya Swaminathan has been appointed to the second-highest position at the United Nations health agency and will soon be taking over as the deputy director-general, World Health Organisation (WHO), in Geneva. A paediatrician and clinical scientist, she also holds the post of secretary in the department of health research in India.

Armed with a post-doctoral medical fellowship in pediatric pulmonology from the Children’s Hospital Los Angeles, University of Southern California, and a research fellowship from the department of pediatric respiratory diseases, University of Leicester, UK, Dr Swaminathan joined the Tuberculosis Research Centre, Chennai, in 1992 and has spent the past 25 years in health research. Known globally for her research in tuberculosis, she aims to free the nation of TB by 2035.

She is the daughter of M S Swaminathan, the father of the green revolution in India. In an interview to AJITA SINGH, Dr Swaminathan says the entire burden of tackling TB lies on developing nations as it is a povertydriven disease and pharma companies – West or East ~ do not like to invest in non-profitable ventures.

Why the focus on TB?

My research interests include pediatric and adult tuberculosis, epidemiology and pathogenesis, the role of nutrition and HIV-associated TB. For two years I was coordinator, Neglected Tropical Diseases at TDR, and have sat on several WHO and global advisory bodies and committees on public health, TB, innovation and intellectual property.

Incidences of multidrug-resistant (MDR) and extensively drugresistant (XDR) tuberculosis (TB) ~ associated with high mortality rate ~ are on the rise in India, while threatening to derail the progress achieved in controlling the disease, researchers say. What is your opinion?

Nearly one in five cases of TB are now resistant to at least one major anti-TB drug and approximately five per cent of all cases of TB are classed as MDR (resistant to two essential first-line TB drugs, isoniazid and rifampicin) or XDR (also resistant to fluoroquinolones and second-line injectable drugs). MDR and XDR-TB which are associated with high mortality ~ 40 per cent for MDR-TB patients and 60 per cent for XDR-TB patients ~ are a threat to health-care workers, prohibitively expensive to treat and are therefore a serious public health problem.

What is the status of TB control worldwide and in India?

TB, caused by a bacterial species called Mycobacterium tuberculosis, is estimated to have killed 1.8 million people worldwide in 2015. Out of these, six countries ~ India, Indonesia, China, Nigeria, Pakistan and South Africa ~ accounted for 60 per cent of the total number of cases of TB. Globally in 2015, there were an estimated 480000 cases of MDR-TB, with approximately half of these cases being in India, China and Russia.

Has ICMR devised an action plan for TB control?

Public health programmes on tuberculosis are under renewed focus because of the high burden of disease in the country as well as in the world. TB exists on an epic scale in India, and cases of multidrug resistant TB are an increasing concern. Access to drugs to treat TB, including drug resistant TB, is a major concern.

Over half a million deaths are due to TB. It is much higher than revised estimates last year. Incidences of multiple drug-resistant TB are increasing with each passing year. In order to control it, focus is being shifted to diagnostic tools. ICMR has initiated End TB Strategy ~ a scheme to end tuberculosis incidences and mortality by the end of 2035. Resistance to anti-tuberculosis drugs is a global problem that threatens to derail efforts to eradicate the disease.

With resistance, the treatment can take years and the drugs used can have unpleasant and sometimes serious side-effects. Though we had an interim goal to reduce by 90 per cent TB mortality and 80 per cent incidence by 2025 and 2030, our Finance Minister announced in the 2017 Budget to bring an end to TB by 2025. Not only has he advanced the elimination date but also accorded more funds for the purpose.

How do you intend to achieve it?

Better tools are needed. Right now diagnosis is by sputum-level examination. (This is) an insensitive test for we miss out on lots of cases. The objective is to develop molecular diagnostic techniques at primary health centre-level that are also low cost. A completely indigenous product has been developed which will replace the costly testing kits. This will be effective in diagnosing extra pulmonary infections and also in children that cannot be diagnosed with sputum.

The Ministry of Health is preparing a plan not only to eradicate TB but also other vector-borne diseases like kalaazar, leprosy, measles and filariasis. Drug combinations are being used for mass drug administration (MDA) too.

What are the challenges before the medical fraternity?

Most are in the field of treatment. In the last 40 years, no new drugs have been developed. Only two new drugs have been identified. The aim is to develop drugs that are efficacious, safe, and have short-term treatments. Drug development is a long, expensive process requiring lots of resources and huge investments.

No pharmaceutical company is willing to put in around 2.5 billion dollars for the purpose as it is not a profitable venture. Actually, TB is a disease of poverty unlike cancer, hypertension, diabetes, obesity or cardiovascular diseases which majorly affect the rich who can shell out big amounts of money. Hence, the governments have to come forward ~ PPP models with industry need to be developed to help link promising leads into drug development and clinical trials.

As ICMR chief did you have any plan for public health?

We have a 10-year strategy that will have five priority focus areas that are very much aligned with the objectives of the ICMR health research.

Can you name some?

First is the health research capacity expansion. Eighty per cent of health research output from 460 medical colleges has nothing significant in so many years. More than half of these have not published a single research paper. This is the state of health research at present. Several schemes are ongoing since DHR was set up. Also new ones have been initiated at medical student level. For instance, we have short-term studentship programmes.

For this some 7000 applications have been received from medical students. Of these, 1,000 are fellowships ~ both JRFs and SRFs. Right now only three universities, including King George Medical University, Lucknow, NIMHANS, Bengaluru, and Chennai Medical College and Hospital conduct research but we would like to encourage MCI to involve more universities in research expansion. New online courses are being developed in medical education.

Five to six thousand doctors across the country are taking up courses in the area of ethics. Regional centres are being developed to act on behalf of ICMR.