India could benefit from bedaquiline, but can’t afford to have just a limited reach for the drug
Given the growing concerns of a rise in drug resistance internationally, and the immense TB burden India faces, the government’s rollout plan for bedaquiline, a new drug to treat multi-drug resistant (MDR) and extremely drug resistant (XDR) strains of Mycobacterium tuberculosis, the TB pathogen, signals a timely intervention. However, given the total number of MDR/XDR cases in the country is over 80,000, bedaquiline rollout through six public hospitals across India—initially, 600 doses will be administered, followed by 2,000 doses—may be a case of ‘too little’, and given the propensity of various strains of M.tuberculosis to develop resistance rather rapidly, may even become a case of ‘too late’ (though the government has talked of strict monitoring of the patients receiving the drug). Experts have warned against calling bedaquiline a miracle drug, given there is a chance that resistance to this could come quicker than imagined.
The drug, discovered by scientists at Janssen, the pharmaceuticals unit of Johnson & Johnson, works by blocking an enzyme vital to the bacteria’s survival. Being the first TB drug to be approved by FDA in over 40 years, it has considerable significance for India, which according to a government report, sees over 2.2 million cases of TB each year with over 220,000 cases of mortality. The government plans to reduce incidence and deaths by 50% and 75% respectively, by 2025. While the new drug is certainly expected to help in reducing deaths related to TB, a major area of concern is identifying cases of TB, detecting cases of MDR and XDR and people completing their course of medication.