Could India’s rapidly expanding medical tourism industry be providing a new route for infectious diseases and drug resistance to spread across the globe?
Senior health officials in the US think so. “We have a problem in India, .” said Dr Anthony S Fauci, Director of the National Institute of Allergy and Infectious Diseases during a Congressional hearing. “We have been getting infections, particularly carbapenem-resistant enterobacteria, through people who go there, for example, on medical tourism and then come back to our hospitals. We now have problems with things that have originated elsewhere.”
Currently, India has a medical tourism industry valued at around USD $3 billion. This figure is projected to triple by 2020. This is an optimistic outlook for the value of the industry and many Indian hospitals are keeping its growth in mind.
Many facilities are expanding appropriately to cater to the incoming waves of medical tourists. Some private hospitals have even adopted the medical tourism industry as their primary customer base, making additions such as luxury spas and ayurvedic wellness treatments.
The surge in the industry is good for the Indian economy and has the potential to provide cheaper medical treatments to many who are seeing costs rise in their home nations. The trade-off for this is the potential for the spreading of disease. Though India is now seeing more deaths linked to non-communicable disease, the country is still a hotbed of infectious diseases. Many of these diseases cannot be found outside of India, such as Kyasanur forest disease.
Drug resistance spreading to other nations is also a very serious concern. Drug resistant tuberculosis (DR-TB), in particular, is becoming increasingly prevalent in India. An estimated 480,000 cases of DR-TB occur every year globally, with many of these located in India. Currently, medications designed to deal with DR-TB are in short supply in India, with only 10,000 doses of Bedaquiline and 400 doses of Delamanid available to the health authorities.
The implication of this is that India is poorly equipped to handle the threat of emerging drug resistant strains. With no domestic production of the medications needed to treat these cases, India is entirely reliant on the import of Bedaquiline and Delamanid. However, even if more doses were available, India probably lacks the requisite diagnostic capacity and the specialised staff to supervise administration of these toxic compounds.
Dr Fauci did note within the Congressional hearing that the US should aim to assist India in addressing the issue, “So we feel we have the responsibility to help them over there,” he said. “Anytime you have a resistant microbe that emerges in another country, inevitably it will come to the United States.”
Strict monitoring for signs of infection before a medical tourist returns home may be a necessary step in ensuring infectious disease and drug resistance does not rapidly spread on a global scale.