HUMANITY seems to be losing the war against tuberculosis (T13).The picture is unnerving - eight million new victims and 2.9million deaths every year; dilapidated national TB programmes; emergence of multi -drug-resistant strains; prohibitive costs of treating the burden of excess cases; receding hopesof new drugs as research budgets shrink; the HIV epidemic andthe resurgence of veteran diseases such as malaria cutting intostatic health budgets. The disease is credited with killing overone million women (leading single infectious cause for femaledeaths in the world) and 1700children every year. Besidesmore HIV-infected individuals die from TB than from any othercause.

Though the picture does not give much cause for optimismmany believe T13 can still be tamed with a concertedglobal effort. Having declared TB a global emergencytheWorld Health Organization (WHO)in collaboration withdonor agencies like the World Bank (W13)is helping developing countries mount a fresh attack on this diehard monster. Atthe same timethe developed world is putting together itsrusty anti-T13 apparatus to tackle the menace. The WHO's planof action - viewed sceptically by many experts - is based onthe wisdom that greater resources and shorter durationtreatment will lead to a greater cure-rate. DOTSor directlyobserved treatmentshort course - as the WHO strategy iscalled - is a combination of four drugs is kill the T13 bacteriaunder close surveillance by health workers.

The WHO's sudden interest in T13howeveris questionable.Says Mira Shiva of the Voluntary Health Association of India(VHAI)Had there not been increasing incidence Of T13 in the developed world because of its association with HIV, it is unlikely that the ongoing suffering and deaths due to it would have really mattered:.. It is in the interest of Western countries to prevent the increase Of TB in the Third World which will continue to be the biggest pool of infection.Indeedthecontinue to be the biWHO's statement on current cases smacks of self-righteousness: "One quarter of all T13 cases in the us are among foreign-born personsand the increasing travel and immigration fromsuch countries adds t6 the spread of the disease. TB cannot becompletely controlled in the industrialised world until it issharply reduced as a health threat in developing nations." Butwould somebody ask the WHO that over the last 15 yearswhenT13 was still raging mad in developing countrieswhy did itallow its tuberculosis unit to decline to the point that a singleprofessional remained in 1989?

A Gordian knot
TBcaused by the bacillus Mycobacterium tuberculosisis a complex ailmenta m