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International Tuberculosis Day: An old foe is back, says The Phantom Plague

‘Phantom Plague’ traces the history of tuberculosis from its origins to its global subsidence and the recent rise, especially in developing countries, offering lessons on  dealing with future pandemics, which it says are not far away

By Rajat Ghai
Published: Friday 24 March 2023

When the World Health Organization (WHO) declared a worldwide pandemic on March 11, 2020, it also advised people to wash their hands thoroughly to prevent the spread of the novel coronavirus, Sars-Cov-2.

Today, we know the importance of handwashing in preventing the spread of disease. But Ignaz Semmelweis, the doctor who first found this out in the 1800s, was confined to a mental asylum where he died after being severely beaten.

I first learnt about the story of Semmelweis while reading Phantom Plague, journalist Vidya Krishnan’s book published in 2022.

The story of Semmelweis is just one of the several vignettes that Krishnan shares in the book.

Using simple language, which nevertheless forces one to reflect, Krishnan provides her readers a 360-degree view of the state of public health in India and abroad.

The title Phantom Plague refers to tuberculosis (TB), one of the most ancient diseases known to humanity. The disease has also been known in history as “phthisis”, “consumption” and euphemistically as “Captain of All These Men of Death”.

TB may be an old disease, but it is ready to wage a fresh war against humankind. And it has a new, powerful ally: antimicrobial resistance (AMR). Many of the antibiotics in use are powerless against drug-resistant TB. It is a ticking time bomb; the next pandemic.

That is what Krishnan warns against in her book. Besides interesting facts, the hallmark of the book is the solid, in-depth reportage that the author has put into covering the danger staring the world in its face.

WHO notes on its website: “Despite being a preventable and curable disease, 1.5 million people die from TB each year—making it the world’s top infectious killer.”

And there is more: “About half of all people with TB can be found in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa.”

TB infects 316 Indians per 100,000, as per the National TB Prevalence Survey 2019-2021, unveiled on March 24, 2022, to mark World TB Day. This is way above the figure of 193 estimated by WHO in 2019.

Krishnan highlights this in her book, when she says that the global battle against TB will be won or lost in India, the world’s largest consumer of antibiotics.

Her book is divided into three parts. The first deals with the historical legacy of TB—from cultural impact (Bram Stoker’s Dracula and his vampirism is an embodiment of disease, she writes) to magical cures. The first chapter, The Grave of Mercy Brown, narrates how people in New England, US, tried curing the disease by exhuming bodies of TB victims, burning their heart and administering the ash to patients.

She then moves on to the struggle to know TB, through vignettes on the lives of Joseph Lister, founder of antiseptic medicine, and Robert Koch, who discovered the TB bacterium in 1882.

But it is Part II where Krishnan really takes off. She explores the “ground zero of TB”—the slums of Mumbai—and uncovers how shoddy government housing policies, dictated by class and caste biases, are making the city a vast incubator of the disease.

Her subsequent chapters in Part II and Part III also uncover the racial aspect involved and how Big Pharma operates in mostly white, western countries.

Research into manufacturing the drugs that will take on drug-resistant TB is being done in developed countries. But most of the patients are in the Global South. Big Pharma is not willing to share the formulas for these drugs with developing nations and has locked them in a web of patents. Patients in developing countries are left alone to die miserable deaths because they did not have access to life-saving drugs.

As Krishnan recounts, this has happened before, when the HIV/AIDS epidemic started in 1981. And it is happening again.

It is not just the West. The Indian government too has a role to play. Krishnan tells the stories of Piya Kumar and Shreya Tripathi. While Piya survived since her family was affluent, Shreya died, spending her last days fighting India’s formidable bureaucracy. Bedaquiline, the drug that Shreya needed so desperately, had been rationed by the Centre. It was available only at six government hospitals in India.

This is a human rights violation, writes Krishnan.

In addition to the West and India’s babus, Krishnan also takes aim at Indian doctors. In the chapter, The Business of Dying, she tells the story of Nandita Venkatesan, who went deaf because her doctors prescribed the drug kanamycin, which causes hearing loss, among other side effects.

Through skillful storytelling, Krishnan lays bare the problem staring at us in the face. Covid-19 has brought global spotlight on public health. And of course, it is not the end of the matter. Scientists and health experts have been warning that the next pandemic could strike any time. The question is not of “if” but “when”, she says.

The most likely cause for the next pandemic could be zoonoses or the jumping of pathogens from animal to human, like Covid-19.

Already, avian influenza has jumped onto mammalian hosts in the past few months.

But Krishnan’s book points out that old enemies like TB could strike us too, with new allies like AMR. And humanity, instead of heeding to whistle-blowers, is only making the entry of the next pandemic smoother. The results, as Krishnan’s book notes, could be catastrophic. Perhaps worse than Covid-19.

This was first published in the 1-15 April, 2023 print edition of Down To Earth

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