Indians have largely remained untouched by the epidemics and pandemics the world has seen over the past three decades. 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 such as cholera, plague, influenza, polio, SARS, Japanese Encephalitis, Chikungunya, H1N1, Nipah etc.
In all these decades, more than 30 new infectious agents or pathogens have been detected worldwide. Around 60 percent of these were found to have a zoonotic origin, carried and spread by animals. COVID-19 has resulted in an unimaginable situation with lockdowns and movement restrictions being imposed in many countries. With a death rate of over 2 lakh around the world, countries are racing to develop a vaccine on the basis of the genetic make-up of the virus which is believed to have mutated in 10 forms already.
Apart from this threat at hand we are facing, there are many other infectious diseases as well which 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 percent of TB population across the world. The majority amongst this number is the adults (aged > or = 15) population but a significant ratio is that of children who are suffering from pulmonary TB.
Tuberculosis is a multi-faceted challenge the country is facing. 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 various challenges associated with TB. Not only is the country home to the largest TB population and associated deaths, but also faces significant challenges panning out from developing an accurate database 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.
Now, 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. But, at first, 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 the 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 of the biggest models India can use from the 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 the 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) and provides intelligence as to which drug will work on the (otherwise naturally resistant) 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 August 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-where one spoke of advantages of BCG vaccine, the other of using the anti-malaria drug or even anti-arthritis drug. This reflects a uniform strategy to fill gaps until we have a designated vaccine for the coronavirus. Where the learnings from an experience were leveraged in this pandemic, it will be smart to leverage the scaled-up learnings from this outbreak to manage other public health issues the country needs to defeat.
—Dr Vedam Ramprasad is CEO, Medgenome Labs. The views expressed are personal
First Published: IST