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For the last three years, tuberculosis has been the world's deadliest infectious disease in the face of AIDS. India accounts for a quarter of all cases and deaths. Many of them have become resistant to traditional antibiotics but new drugs may offer new hope to these patients.
From our correspondent in India,
Sunny is squatting in the doorway of her tiny house in Narela slum, located in the far north of New Delhi. Cans of water line up against the outside wall as children heckle in the middle of the clothes hanging across the street. Sunny, 20, stares at them, stunned. For two years, the life of this young boy is in suspense. All his energy is gone in his fight against this pernicious disease: tuberculosis. " It was July 2017, he recalls. I was very weak, I coughed a lot. It was first thought that it was dengue or chikungunya. Some tests and radios at the public hospital finally confirmed his infection. " I started taking the drugs, but they made me throw up. I fell unconscious, at least twice in a week. So I stopped taking them . Sunny did not heal. Worse, he became resistant to these antibiotics. When he resumed his treatment six months later, the doctors then prescribed him even stronger drugs for one year. " 7 red and white pills a day, thinks to remember Sunny, the weak voice. I finished them at the end of August. I am told that I am healed. But I remain very weak. I can not run, I'm running out of steam very fast. "
27 % of tuberculosis patients live in India
This course is unfortunately common in India. the World Health Organization (WHO) estimates that 2.7 million Indians catch TB each year, of which the authorities managed to identify and treat 2.15 million in 2018. This represents 27% of estimated cases of tuberculosis in the world. For three years, this century-old disease has become the most deadly infectious disease, in front of AIDS. In 2017, 1.6 million people died of TB, including 421,000 in India (of whom 300,000 and 11,000, respectively, also had AIDS).
WHO aims to eradicate this disease in 2030 and this can not be done without a radical reduction in India. New Delhi follows this movement In three years, the Indian authorities have more than doubled the budget allocated to the fight against tuberculosis, to establish it to 418 million euros in 2018 (+ 110 million foreign donations). India intends to eradicate this disease by 2025, which is an extremely ambitious challenge.
Drugs with devastating side effects
The treatment of tuberculosis is indeed long and complicated: it involves taking a minimum of four drugs a day for at least six months. These antibiotics can be very difficult to support and doctors must therefore follow patients closely, which is an impossible task in India, where public hospitals, free, are overwhelmed. Many therefore stop treatment as soon as the first symptoms disappear and, like Sunny, become resistant to antibiotics.
The WHO estimates that 135,000 Indians were "multidrug-resistant" in 2017, that is, they were no longer responding to at least two first-line antibiotics. The treatment of these patients then becomes complex, even experimental, because it passes by the long-term administration of antibiotics planned for other infections. Some, in the form of injections, have devastating side effects. Nandita Venkatesan, a 29-year-old Mumbai middle class journalist, fought two intestinal tuberculosis in eight years. The last, multi-resistant, became " uncontrollable ", she testifies. " I had to undergo 6 surgeries and I lost part of my hearing because of Kanamycin injections. It's an old medicine, very harmful . Now she only hears through a hearing aid.
Two new antibiotics could save these patients
It is estimated that only half of multidrug-resistant TB patients are identified and treated in India. And less than one patient in two heals. About 30,000 Indians are dying each year at a slow pace from this very aggressive form of tuberculosis.
But this is changing. For the first time in 50 years, two drugs have been invented specifically to treat multidrug-resistant tuberculosis: Bedaquiline and Delamanide. These drugs were approved by US and European authorities between 2013 and 2014. But they are slow to reach Indian patients. First, because they are very expensive: 365 euros for Bedaquiline and 1,550 euros for Delamanide, for the treatment of a single patient for six months. An exorbitant cost for India, considering the number of patients.
In the past three years, the Ministry of Health has received only 22,000 six-month treatments, in the form of donations and 400 from Délamanide. They are now administered with great care, to avoid abuse and resistance to these "last-ditch drugs." But for some, these restrictions are criminal: " the WHO has placed the Bedaquiline in category 1, which means that it has very good results, says Ganesh Acharya, activist for access to medicines. The 150,000 patients (multidrug-resistant, ed) should benefit immediately. Because today, these people, either they die, or they spread the disease. The government must declare a health emergency and buy Bedaquiline . "
According to Kuldeep Singh Sachdeva, Deputy Director of the National Tuberculosis Program, " there is no lack of Bedaquiline, because not all MDR-TB patients are eligible for this drug. This antibiotic causes, among other things, strong heart palpitations. However, he says that the Ministry of Health should, for the first time, purchase 33,000 treatments for this new drug in the coming months. A first step to contain this epidemic of multidrug-resistant tuberculosis.
This report was funded by the European Journalism Center (EJC) via its Global Health Journalism Grant Program for France .
► To listen too: Tuberculosis in India, the fight against a forgotten plague
►This report was funded by the European Journalism Center (EJC) via its Global Health Journalism Grant Program for France.