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 (PCR) tests were done for Covid-19 Why are we still using century-old microscopy for tuberculosis? We can and must do better!” Accompanied with a messy, unhygienic kitchen sink with racks of slides (presumably for sputum testing, requiring the patient to violently cough up phlegm from the lungs), there could not have been a more convincing argument to change the way testing is being done for Tuberculosis, pronto.
But why has time stood still for TB at what might conveniently be called ancient smear microscopy?
“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. The fact that we are still using a century-old BCG vaccine today speaks volumes about the scale of neglect. Investment in Covid-19 vaccines was probably 1000-fold higher! 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 (molecular) testing for COVID-19.”
