Tuberculosis and Inequality: How Race, Caste, and Class Impact Access to Medicines
Vidya Kishnan and  Garry Aslanyan on "Dialogues,"  a new series from the Global Health Matters podcast.
Vidya Kishnan and Garry Aslanyan on “Dialogues,” a new series from the Global Health Matters podcast.

The elimination of tuberculosis cannot be achieved if medicines are locked in a “patent panoply,” according to Indian author and journalist Vidya Kishnan.

Speaking to Garry Aslanyan on the most recent episode of Dialogues, a new series from the Global Health Matters podcast, the author of “Phantom Plague: How Tuberculosis Shaped History” said that “everything that happened in COVID has been happening for decades with TB.

“In India, the entire TB program got ‘Covidized,’ down to the helpline of the Ministry [of Health], and infections and respiratory diseases don’t simply go away,” Kishnan said. “So, the first thing we need to do is look at how technology is transferred because vaccines and drugs first and foremost, it’s technology. It’s somebody’s intellectual property. And I feel like TB elimination cannot, will not be achieved if the medicines, the latest most humane therapy, is locked in a patent panoply.”

The most exasperating aspect, according to Kishnan, is that the advancements in tuberculosis therapies resulted from a sincere collaboration within the public domain. Universities, student funds, and philanthropic contributions collectively supported these efforts. Notably, several late-stage clinical trials for bedaquiline took place in India and South Africa, with patients actively contributing to the process.

“It’s really unfair that you use patients for research, but then when … all of these drugs came out of industrial scale subsidies to pharmaceutical companies, and others in patent panoplies.”

Throughout her writing career, Kishnan has dedicated considerable effort to investigating and documenting the profound impact of tuberculosis on individuals from various backgrounds in India. In her book, she delves into critical questions concerning the intersection of race and caste within policies that shape the dynamics of tuberculosis spread and control in the contemporary context of her home country.

Kishnan tells Aslanyan that in India, people live in congested cities and are still segregated by race, caste, and class. Pathogens do not respect these boundaries. However, the rich generally access medicines, whereas the poor are left behind.

In India, tuberculosis has reemerged as the foremost infectious disease killer. She said the lessons from previous pandemics underscore a fundamental truth: No one can be considered safe until everyone is protected from the threat.

“I feel like a stuck record saying this over and over again everywhere I speak. But it was quite surreal to see the science denialism and the racism and casteism in my country, all of the things I had read about, the xenophobia, all of it just came to life in the past three years,” Kishnan said. “If we are greedy and if we think in these myopic ways, I don’t see any way we will prevail over these pathogens despite all the fruits of modern medicine.”

Aslanyan concluded: “This conversation reminds us, as global health professionals, of many challenges on the long road ahead toward the ultimate goal of tuberculosis elimination and the importance of community engagement.”

Listen to previous episodes of Dialogues on Health Policy Watch.

Image Credits: Global Health Matters (TDR), Global Health Matters Podcast (TDR).

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