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Old diseases in a brave new world
Given the challenges of new strains in diseases that are drug-resistant, the need for Governments across the world including in India, and the pharmaceutical industry, to work towards the next generation of antibiotics, will be critical
The re-emergence of diseases presents a major public health challenge over the next decade. Tuberculosis, malaria and other vector borne diseases along with the rise of multi-drug resistant pathogens present a major challenge to the health and well-being of communities.
Diseases that afflict humans, typically fall under what may be referred to as the ONE triad, the old diseases — vector-borne, communicable and largely those that have been tackled through public health initiatives over the last quarter of a century. New diseases — lifestyle and non-communicable diseases — which, while having existed for centuries, have emerged as a significant health challenge for the world in the past quarter of a century. Lastly, there are the emerging diseases — primarily viral in origin, mutations of existing diseases or a new class of diseases, that can pose significant challenges for public health.
Diseases like zika, ebola, yellow fever and west nile virus, all fall under this category. These diseases by no means cover the entire spectrum of health challenges posed by pathogens, diseases of genetic origin or those caused due to a longer living population, but they do constitute in terms of disease burden, the most significant challenge to public health at large.
The rise of the old diseases in the past few years has been particularly worrisome. The past quarter century had seen an unprecedented collaboration the world over, with countries, communities and citizens coming together to stem the tide of diseases like tuberculosis, polio, malaria and infectious diseases.
The development of drugs and vaccines, especially antibiotics, their wider distribution along with development of health infrastructure and delivery and better access to sanitation and clean drinking water, all contributed in registering wins in our collective battle against diseases.
Take, for example, small pox. A disease that has a millennia-old history of scourge against humans, killed more than two million people and afflicted another 10-12 million people in 1967. Concerted action and a wide-ranging vaccine programme in that decade ensured that the world was declared free of small pox in 1979.
Similarly, the eradication of polio from the world remains one of the most significant stories of human achievement. The World Health Organisation (WHO) estimates that polio cases have decreased by over 99 per cent since 1988. From an estimated 350,000 cases then to 74 cases in 2015, the united efforts of the global community helped children and citizens from the crippling clutches of a once dreaded disease. While these notable victories are significant, a new challenge has emerged over the past few years.
The rise of multi-drug resistant tuberculosis has emerged as a major health challenge. The Centers for Disease Control and Prevention reports that in 2014, 9.6 million people around the world became sick with TB. There were an estimated 1.5 million TB-related deaths worldwide. India itself is estimated to have had over 2.5 million TB cases in 2014.
Further, it is estimated that 40 per cent of the Indian population is infected with the TB bacteria, the vast majority of whom have the latent version. But TB prevalence has fallen to a significant 40 per cent between 1990 and 2015, with an average fall rate of about 1.5 per cent per year between 2000 and 2014.
So, why worry? While the battle against tuberculosis seems to be slowly won, a new threat has emerged. The rise of multi-drug-resistant tuberculosis (MDR-TB) and its even more problematic variant, extensively-drug-resistant tuberculosis (XDR-TB) has opened a new battlefront. MDR-TB and XDR-TB are resistant to treatment and have primarily emerged due to poor adherence to TB treatment and the rise of drug-resistant variants of the bacteria itself.
In 2014, the WHO estimated that 480,000 people developed MDR-TB, of which an estimated 9.7 per cent developed XDR-TB. The fear of most doctors and scientists is the rise in these numbers, where even our best ammunition against TB may prove ineffective. Further, a mutation in the bacterial make-up may make MDR-TB a threat to an even larger section of the population.
Antibiotic resistance poses the second significant threat to the world. The past few years has seen the rise of mutated forms of common diseases that have developed significant immunity against antibiotics. A recent study in the British Medical Journal on pediatric urinary tract infections by E Coli, a very prevalent disease causing bacteria, revealed a high level of antibiotic resistance by the bacteria. More worrisome was the higher prevalence of resistance in low and middle income countries. The WHO has called antibiotic resistance an “increasingly serious threat to global public health that requires action across all Government sectors and society”.
Given these challenges, the need for Governments and the pharmaceutical industry to work towards the next generation of antibiotics will be critical.
(The writer is general manager, Operation &Public Affairs, Indraprastha Apollo Hospitals)
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