The evil superbug is on the lookout for new hosts. The hero has the weapon, he can conquer it, but only if he is willing.
The superbug is antibiotic-resistant bacteria, which causes multi-drug-resistant tuberculosis (MDR-TB), the life-saving weapon is bedaquiline and the reluctant hero is the government.
The World Health Organisation (WHO) has estimated that 79,000 Indians—the largest number anywhere in the world—were infected in 2015. Without large-scale treatment or prevention of transmission, it is estimated that at least a similar number of Indians contracted the superbug in 2016. Doctors treating patients suffering from TB say that the figures are an understatement as a large number of cases are not even diagnosed, leave alone reported. One of the best cures is bedaquiline, the first drug to be approved in 50 years for such a resistant TB.
The Belgian drugmaker Janssen, a sister company of Johnson & Johnson (J&J), has developed the drug, which became available in the global market in 2012. In 2014, Janssen made a donation for 600 patients in India, which the Directorate General of Health Services in New Delhi approved for ‘conditional access’. It’s a drop in the ocean, where at least 79,000 patients are estimated to be infected every year and do not have access to bedaquiline. A pilot has been going on in five cities but only patients in these cities could access the drug until a fortnight ago.
So while the donation in the past meant that the drug could enter India, it also meant that it was not available in the market. Patients are scrambling. Two weeks ago, the Delhi High Court ruled in favour of an 18-year-old girl from Patna who had filed a case against the Government of India for denying her access to this drug on the basis of her domicile.
The distribution of the drug remains a challenge but the government has now sought more donations—2000 courses out of a pledged package by J&J of 10,000 courses, under the USAID.
“The pilot was used for a programmatic feasibility study, to study any adverse events through pharmacovigilance. About 200 patients are on treatment, and there have been three deaths [which is within acceptable limits],” said Soumya Swaminathan, Director-General of the Indian Council of Medical Research in Delhi.
The restricted use of this drug is fuelling the spread of MDR-TB. Studies in South Africa have shown that the sooner such patients are put on bedaquiline, the better the outcomes for them and the community.