Nobel pursuits, and infectious diseases

The October week began well for the health team. The undeniable high of witnessing yet another Nobel Prize for Physiology or Medicine acknowledging steadfast contributions in research was the high point of this week. The announcement of the Nobel for Katalin Karikó and Drew Weissman for their “discoveries concerning nucleoside base modification that enabled the development of effective mRNA vaccines against COVID-19”, did not come as a surprise for most people. After all the Nobel is an acknowledgement of discoveries of great benefit for mankind, and closest in memory is the stunning turnaround in how the mRNA technology was effectively employed in creating an effective delivery mechanism for the vaccine against the virus. It was Dr. Karikó and Dr. Weissman who did the grunt work that pushed the mere possibility of an mRNA vaccine into a viable therapeutic methodology, well employed nearly 15 years later, during COVID-19. 

The basic idea was to inject the body with a modified mRNA that would instruct cells to build a certain protein, which could then provoke the body’s immune system to ‘attack’ it as well as prepare itself for encounters with the same protein in future. This protein could be something produced by a virus – such as the spike protein of SARS-CoV-2. But the mRNA would have to survive its journey inside the body and be able to enter a cell, without causing adverse reactions while inside the body. That is what the Nobel-winning duo helped facilitate, working from the 1980s, despite all odds, and deterrents that were making the possibility of using mRNA for therapeutics seem ridiculous. For this, for the triumph of human endeavour against biochemical and immune systems, the Karikó-Weissman duo were well-feted. Do read our report here: Medicine Nobel for the technology that turned the pandemic. For more details about the vaccine technology itself, do read this explainer on mRNA vaccines by Priyali Prakash. And yes, it’s natural to want to know more about the 13th woman to have won a medicine Nobel, so we have a profile on Katalin Karikó, the scientific maverick who paved the way for mRNA vaccines here for you.

The euphoria surrounding a Nobel announcement was nevertheless dented this year, as the sobering reality of a massive TB drug shortage in India made news, last week. R. Prasad explains here if there is indeed a TB drug shortage in India. The TB drug shortage in the country began last year when Rifampicin — a medicine used for treating drug-sensitive TB — was not available in many parts of India. Since June this year, three important medicines used for treating drug-resistant TB — Linezolid, Clofazimine, and Cycloserine — too faced a stockout. The Health Ministry issued two denials, one in end September, and then, again, one on October 1, saying media reports are exaggerated, and that there was no stock-out position, though the first release did mention that on rare occasions, States were requested to procure TB drugs on their own.

In a sharp statement, the second one, on October 1, the Ministry asserted that there was sufficient stock of all anti-TB drugs in the country and that media reports to the contrary were “not only inaccurate and misleading, but also do not reflect the correct picture of the available stock of anti-TB drugs in the country”. The Centre proactively undertakes regular assessments to evaluate the stock positions at various levels, from central warehouses to peripheral health institutes, it said. Treatment for drug-sensitive TB consists of two months of taking four drugs, available as 4FDC (Isoniazid, Rifampicin, Ethambutol and Pyrazinamide), followed by two months of three drugs available as 3 FDC (Isoniazid, Rifampicin and Ethambutol).

Meanwhile, in continuing coverage on TB, Bindu Shajan Perappadan noted the welcome news that Johnson & Johnson had decided not to enforce patents on the TB drug Bedaquliline, a very important drug for treating multi-resistant TB. Of course, this comes at the end of a long string of events, the most recent being the Indian Patent Office’s rejection of the company’s secondary patent application for the drug – a move that we owe to the efforts of Nandita Venkatesh from India and Phumeza Tisile from South Africa. This was followed by global pressure on J&J to not pursue secondary patents on its breakthrough tuberculosis drug. This move will now allow manufacturers to produce lower cost, generic versions of bedaquiline. 

In other TB news, Anupama Srinivasan, Ramya Ananthakrishnan and Manjot Kaur of REACH, write on how India, with its ageing population, needs age-responsive TB care. India’s National TB Prevalence Survey, 2021, revealed that the prevalence of TB in people over the age of 55 was 588 (per one lakh population), much higher than the overall national prevalence of 316. These findings were the starting point for a first-of-its-kind rapid assessment report on TB among the elderly, published earlier this year in collaboration with the National TB Elimination Programme and the U.S. Agency for International Development, highlighting TB’s impact on the elderly and the need for age-specific TB guidelines. 

In this report, Maitri Porecha speaks to Dr. Vijay Vishwanathan on the need to screen TB patients for diabetes also. The latter’s latest research published earlier this year, directed the spotlight on TB patients who do not conventionally fall under the ‘diabetic’ category, but have HbA1C levels between 5.7 and 6.4, or elevated fasting glucose levels between 100 and 125 mg/dl.

With World Heart Day falling on September 29, coverage naturally focussed on the consumption of salt: Indians continue to eat more salt than the World Health Organisation recommendation. The WHO report released last week on hypertension also indicated the urgency with which Indian health managers must handle hypertension in the country. Reducing the levels of salt consumed is billed to be one of the most significant interventions to preventing hypertension, and keeping it under control. Naturally, of course, it follows that lifestyle modifications can reduce the chances of heart attack, say cardiologists. 

States are also preparing to tackle this. Tamil Nadu has stocked emergency loading doses of drugs against heart attack at the PHCs, in an effort that is sure to save precious lives; Kerala’s health department has planned to launch a heart health campaign; in Karnataka, the Bangalore Metropolitan Transport Corporation did an evaluation of its employees to understand their risk for cardiac diseases. 

Happy to report that the Nipah virus scare has receded again in Kerala as four cured patients go home. However, the better part of valour is caution and the State would do well to step up its infectious diseases surveillance programme, given it has experienced the fourth outbreak of Nipah. As an addition, here’s a story on why BSL-3 lab for Nipah confirmation is unnecessary.

In other news, the National Medical Commission’s latest order on seat allocation is being viewed as unfair to the southern States. The recommendation that colleges seeking approval from the National Medical Commission should follow the ratio of 100 MBBS seats per 10 lakh population will punish States that have performed well on this population control, and undermine federalism in healthcare, say doctors. Siddharth Kumar Singh records the objection of experts in Telangana to this move that is bound to disadvantage the Southern States, and the reversal of incentives for population control. 

Nipah may be past, but there is a definite dengue surge in different parts of the country, and it might be time for us to learn more about what the disease is and how it spreads, its treatments and cures. Serena Josephine M. provides a primer on understanding the ABCs of dengue for control and better management.

ICMR is set to find out if flu vaccines can reduce respiratory infections in the elderly, though there is worldwide research has proven that flu injections do indeed bring down mortality in senior citizens and reduce hospitalisations.

We heard of Neuralink last week, this time, here is news that brain implants could restore paralysed patients’ arm movements. Technology coming to the rescue of health care is always a fascinating area. 

Our tailpiece this week chose itself: @theliverdr – a popular account on X, formerly Twitter – was in the limelight last week as an ex-parte induction passed by a court in response to a suit filed by Himalaya Wellness Corporation denied him access to his X account. Cyriac Abby Philips, a hepatologist based in Kerala, had been using X to propagate messages that were pro-liver health, and in the process, a number of alternative systems of medicine came under fire. But it’s not like Dr. Abby to give up, and he is not; he has said he will mount a legal battle to retrieve his account. The curtailing of freedom of expression in general is condemnable, responsible use of this freedom is the ideal. 

From the Health pages

If you have a few extra moments today, you may not want to miss out on these stories: 

If anxiety is in my brain, why is my heart pounding? A psychiatrist explains the neuroscience and physiology of fear, by Arash Javanbakth.

Reform can address India’s kidney transplant deficit, say Jay Mehta, Utkarsh Agrawal and Jeevant Rampal.

Wegovy, other weight-loss drugs, scrutinised over reports of suicidal thoughts. 

Central Government hospital steps in to bat for transpersons’ health.

Erring medical colleges to face monetary penalty soon.

What does it mean to have a uterus transplant? explains Rebecca Rose Verghese.

New UNFPA report finds India ageing, elderly to make up 20% of the population by 2050, writes Abhinay Lakshman.

The Union Ministry of Animal Husbandry and Dairying deleted a social media post on rabies after facing criticism.

Traditional medicine provides health care to many around the globe – the WHO is trying to make it safer and more standardised.

For a smattering of regional reporting on health from across our bureaus, read below:

Bihar

Bihar reports 6,146 dengue cases in September, highest in the last five years.

Karnataka

Ayushman Bharat Arogya Karnataka: State tops in treating most number of women beneficiaries, reports Afshan Yasmeen.

Dharwad District Hospital tops the country in linking the highest number of health records under the Ayushman Bharat Digital Mission in one year.

Kerala

Vaccine programme to prevent cervical cancer on the anvil, says Chief Minister Vijayan.

Tamil Nadu

Health officials issue guidelines for the public as part of dengue prevention measures in Salem.

Telangana

U.K.-based charity and NIMS Hyderabad save young lives.

Telangana recorded 5,263 dengue cases this season.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.

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