Dr Zarir F Udwadia is a consultant chest physician who was the first to discover Totally Drug-resistant TB (TDR-TB) in 2011 which attracted international media and scientific attention from across the globe.
Tuberculosis (TB) is a major threat to world health. After HIV/AIDS, it is the most common cause of death from an infectious disease. But Dr Zarir F Udwadia is giving hope to thousands suffering from this dreaded disease. He practices at Mumbai’s Hinduja Breach Candy and Parsee General Hospitals.
He is interested in all aspects of respiratory medicine, with special academic and research interest in TB, MDR-TB, pulmonary infections, interstitial lung disease, sarcoidosis, sleep medicine, asthma, emphysema and bronchoscopy. He talks about the disease and the initiative taken by the government and private bodies to eradicate it…
Treating and helping cure thousands of patients with drug resistant TB (many of whom were told they may not survive long) is the clinical highlight of my career.
Q- What are the challenges you faced to eliminate TB?
The challenges are lack of funds, lack of political will and an inefficient and underfunded program, as a result of which the number of TB patients and number of deaths from TB has shown no sign of reducing, but has in fact increased.
Q- How is TDR-TB difficult from XDR-TB?
TDR-TB as we defined it in 2012 is resistance to 12 first- and second-line TB drugs. This represents the sum total of the drugs we had available then. Since there are less drugs available, it is even more difficult to treat than MDR-TB or XDR-TB.
Q- What, according to you, is the role of the private sector?
The private sector is chaotic and incompetent when it comes to treating MDR-TB. In a study we performed in Dharavi, only three of 100 private doctors could prescribe correct treatment for an MDR-TB patient. The majority of medication was inappropriate and would serve only to worsen and amplify drug resistance.
Q- What has been the biggest influence in your career?
My father, a reputed physician, is still active and practicing at the age of 85. Still erudite, and eager to teach and learn. A truly renaissance man.
Q- What according to you are the most far-reaching changes in the field of drug-resistant TB?
The two most far-reaching changes I have seen are: the advent of a ‘game-changing’ new test, the GeneXpert, that can diagnose resistance in a few hours instead of the traditional eight weeks, and the success of the two new drugs (after a wait of almost 50 years for a new drug), Bedaqualine and Delamanid, in clinical trials around the world.
Q- What have been the greatest achievements of your professional life?
Treating and helping cure thousands of patients with drug-resistant TB, many of whom were told they may not survive long, is the clinical highlight of my career.
The academic highlight must remain the publication of our series of the first patients with TDR-TB. I never expected this simple two-page publication in Clinical Infectious Disease to have the impact it did. It was covered by a large number of international publications and sites including Time magazine, Wall Street Journal, New York Times, Reuters, BBC, CNN, Scientific American etc.
Q- What do you think is the future of rapid diagnosis and drug provision?
GeneXpert machines should penetrate the length and breadth of the country. More reference labs capable of performing drug sensitivity studies are also needed. Rollout of the new drugs in a responsible way to the thousands of patients who are currently dying from their lack is also needed.