Tuberculosis is a global emergency. It challenges the ability and will of the governments everywhere to evolve the right policy mix to foster the health of the vast masses of the disadvantaged people, says Dr.C.N.Deivanayagam of Chennai, an acknowledged expert and a rebel among Indian physicians.

There is no dearth of reports to show that Mycobacterium tuberculosis Hominis (MTB) (the scientific term for the dreaded TB) is spreading its tentacles across the globe. Both its virulence and reach are of terrifying proportions.

Tuberculosis is one of the world's leading infectious killers - second only to HIV/AIDS, admits the World Health Organisation (WHO). Each year about 1.6 million people die from this curable disease, it despairs.

The latest Global Tuberculosis Control Report of the WHO, released ahead of the TB day, does proclaim that the percentage of the world's population struck by TB had peaked in 2004 but has held steady in 2005.

However the WHO also admits that while percentage-wise the TB incidence is showing some decline, in absolute numbers, it is still forbiddingly high. But then that is because the population is outpacing the efforts to control the disease.

Similarly, the official website of the Directorate General of the Health Services of the Indian government, is gung-ho about the WHO-inspired Revised National Tuberculosis Control Program (RNTCP), and its key strategy of Directly Observed Treatment, Short-course (DOTS).

The figures reeled out by the Directorate General of the country - 600,000 health workers, more than 11,500 laboratory microscopy centers, covering the entire population of the country, 3,500 patients started on treatment every day, and consequently a success rate of 86 per cent in treatment, as against only 25 per cent earlier – are indeed impressive by any standards.

But Dr.Deivanayagam is not convinced. He believes that whoever designed the DOTS of the WHO has failed to take into account the ground realities. He shrugs away all the numbers bandied out and says acidly, ''From the way the program is structured, the abysmal poverty in which vast masses are sunk across the globe, the highly unhygienic conditions in which they are forced to live, the all too obvious lack of political will on the part of many governments to tackle such root causes and the consequent explosion in the numbers of the TB-patients, it is inconceivable that any dent has been made anywhere.''

He notes that the very idea of making the TB patients visit the clinics thrice a week for treatment and collect medicines under the DOTS is almost outrageous. For how many can afford to trek to the nearest clinic that many times a week, who will pay them the transport fare and who will compensate them for the loss of the wages? he wonders. And any interruption in the administration of medicine could be fatal for the efficacy. But such is the way the entire regimen has been conceived, it is bound to fail, Deivanayagam asserts.

He still swears by the previous Self-Administered Therapy (SAT) where the patients are given medicine at one go for a month.