Context

India needs to take TB at the same level of seriousness at which it is dealing with the Covid-19.

Contrast and between the response

• Tuberculosis in India: Indians will still have to contend with other deadly respiratory tract infections which spread via airborne transmission. We will still have to contend with one particular bug which kills millions of us and which has been around for millennia. Tuberculosis.
  • But all comparisons between COVID-19 and TB end with the superficial observation that they are both deadly respiratory tract infections.
• Speedy tackling of COVID-19: COVID-19 began its march through humankind barely half a year ago and, in record time, scientists have identified the virus and hundreds of millions of dollars have been allocated to controlling its spread, developing vaccines (at last count, more than a dozen candidates) and testing medication regimens for those infected.
• Waning of the epidemic: While the virus has spread to over 100 countries, the epidemic already shows signs of waning in the Asian countries where it hit first and hardest.

Response to the TB

• How long has the TB infected us? On the other hand, TB is as old as humanity itself, infecting us for at least 5,000 years.
  • The infecting agent, a bacterium, was identified way back in 1882, by Robert Koch, signalling one of the landmark discoveries which laid the foundation of modern medicine.
• How was the response to TB? The subsequent response to this disease, which was infamously called the White Plague and was a leading cause of death globally at the start of the 20th century, is similar to what we see today for COVID-19, but played out over decades rather than months.
  • Measures taken: TB was made a notifiable disease, campaigns were launched to prohibit spitting and containment policies, including sequestering infected persons, were implemented.
• The first vaccine was produced over a hundred years ago, and the first curative treatments available by the 1950s.
• Divide between rich and poor in TB infections: TB was largely beaten in the rich world, not only because of these medical miracles but also thanks to the dramatic reduction in poverty and improvement in living standards.
  • There is compelling evidence that addressing these social determinants was even more impactful than medical interventions in the war against TB.
• The disease of squalor: TB has always been, and this is even more true now than ever before, a disease of poverty and squalor. And no country is more affected than India.
• Every TB statistic is grim:
  • We are home to 1 in 4 of the world’s TB patients.
  • Over 2.5 million Indians are infected.
  • In 2018, over 4,00,000 Indians died of the disease.
  • To put this in stark perspective, more people died of TB in India last week than the entire global death toll of COVID-19 to date.
  • Contrast with the response to COVID-19: Given our urgent, energetic and multifaceted response to the latter Covid-19, one is left wondering why we have failed so miserably for another bug, particularly one which has been around for so long, which has been exquisitely studied and characterised, which is preventable and treatable, and which most of the world has conquered.

Why TB has not been given such attention?

• It is because those who suffer from TB are not likely to be boarding international flights or passing through swanky airports to attend conferences.
• It is because TB infects people in slower tides, slow enough for industries to replace the sick with healthier recruits without endangering the bottom line.
• It is because TB does not threaten the turbines that keep the global economy throbbing.
• It is because TB no longer poses a threat to rich and powerful countries.
• It is because those who have TB live on the margins and have little political influence.
• It is because TB control requires society to address the squalid environments, which shroud the daily lives of hundreds of millions of Indians.
• It is because TB is a medieval scourge that reminds us of our shameful failure to realise a just, humane and dignified life for all our people.

Conclusion

If there is one lesson from COVID-19, it is that India, and the global community, has the political will, technical capacity and financial resources to act in a committed and concerted way to control infectious diseases. It needs to marshal these assets to eradicate TB, the most pernicious and pervasive infection of all, both through addressing its social determinants and scaling up effective biomedical interventions. But, for this to happen, we will have to be as concerned about the health needs of those who travel by foot and bicycle as we do for those who board cruise ships and international flights.

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