TB testing stuck in the previous century, and waiting for change

The frenetic pace of activity in some areas of science is only matched by lethargy in others. A classic case, as Madhukar Pai, renowned researcher on Tuberculosis and Associate Director, McGill International TB Centre, McGill University, Canada, put it in a tweet as a pithy foreword to his article in Nature: “Billions of molecular tests were done for Covid-19 Why are we still using century-old microscopy for tuberculosis? “The simple answer,” Dr. Pai says, “is that few people care about TB, and the investment in R&D has been so little over the past century. So, it is deeply frustrating that many high-burden countries, including India, are still so heavily reliant on microscopy, when nearly every country, including India, scaled up PCR testing for COVID-19.” Dr. Pai co-authored with Soumya Swaminathan and Puneet K. Dewan, an article arguing fiercely for ‘Transforming tuberculosis diagnosis’ in the May 1 issue of Nature Microbiology. “Interestingly, even when investments were made and good products like CB-NAAT were developed, many high burden countries have limited their use only to certain special risk groups, instead of replacing microscopy with molecular testing,” Dr. Pai adds.