Why India Has the Most Tuberculosis Deaths

Government bureaucracy, lax international guidelines, and high drug prices have created a toxic cocktail.

Charlotte Silver

September 24, 2019

Why India Has the Most Tuberculosis Deaths
Most of the newer, more effective tuberculosis medicines are not available in India. (Abhilash Baddha)

Jayashree Bahire, 54, had blackened, cracked skin. Her emaciated, 60-pound body showed the failure of the antibiotics she was taking to treat one of the world’s most intractable diseases — tuberculosis (TB).

India is the hardest-hit country in the world — TB killed around 410,000 adults in India in 2017, about a quarter of worldwide TB deaths, followed by Nigeria (120,000) and Indonesia (107,000). 

India is also home to the largest population of drug-resistant TB patients, with conservative figures estimating 150,000 new cases a year. These patients are resistant to at least one drug that could treat TB. These strains can further mutate into multidrug-resistant TB (MDR TB), a form of TB where patients are immune to typical TB treatments, and extensively drug-resistant tuberculosis (XDR TB), a rare form of MDR TB where patients are immune to nearly all TB antibiotics. 

Bahire has XDR TB.  

Though it had been six years since Janssen and Otsuka Pharmaceuticals introduced two new, highly effective antibiotics — Bedaquiline and Delamanid — to treat deadly strains of tuberculosis, only 4.5% of Indian patients, or about 7,000 people, have access to Bedaquiline, and even fewer to Delamanid. Most are stuck taking older, toxic injectables — Capreomycin and Kanamycin — which don’t work for large swaths of drug-resistant patients.