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Keeping the tuberculosis fight alive after the World TB Day spotlight fades

Posted: 2 Jun 2016

Dr. Grania Bridgen, TB Advisor for Médecins Sans Frontières, writes for Eldis on the rise of drug-resistant forms of tuberculosis, and the call to action to adequately fund the fight against drug-resistant TB. Follow Graina on Twitter: @TBbrigden

On World TB Day, tuberculosis (TB) enjoys its brief moment in the spotlight and it becomes clear that this disease is not just confined to the history books. Global figures show that not only has TB not disappeared, but that the lack of interest and investment in TB means that the rise of drug-resistant forms of TB is now at levels that can not be ignored.

Multi-drug resistant TB (MDR-TB) is a form of TB that has become resistant to two of the strongest antibiotics used in the standard 6-month treatment for tuberculosis. Drug-resistant TB was originally caused through incorrect use of the drugs used to treat tuberculosis, but now MDR-TB and other even more deadly forms of drug-resistant TB are spreading directly from person to person, even to those who have never had TB before. 

Drug resistant TB infographic


 

Years of chronic underinvestment in TB means that only 25% of patients with MDR-TB are properly diagnosed -- the most commonly used diagnostic test is more than 100 years old and does not detect MDR-TB. Patients “lucky” enough to be diagnosed are faced with a gruelling two-year treatment that includes 8 months of injectable antibiotics and more than 14,000 tablets, both of which cause side effects ranging from deafness, intractable nausea and vomiting to suicide. Those who do complete the treatment have only about a 50% chance of being cured.

Why is this? Well, not only is the most widely used diagnostic test 100 years old; until 2012 there had been no new drugs developed for TB in more than 50 years! Now we’re pinning our hopes on the two new TB drugs that have been approved, although only in a few countries so far, and only to treat the deadliest forms of drug-resistant TB. We still have a long way to go before patients can broadly benefit from these advances, and it will be years before a shorter, less toxic and more effective treatment regimen for drug-resistant forms of TB is widely-available.

This is because TB mainly affects people in low and middle income countries, and affected populations don’t represent a profitable market for pharmaceutical companies. As a result, research and development (R&D) for innovations in TB prevention, diagnosis and treatment is not prioritised and is drastically underfunded; there just aren’t enough financial incentives in place to attract significant research for TB. Both a healthy pipeline of future drugs to combat the TB bacteria as it continues to evolve and mutate, and collaborative research focused on testing drug combinations, are needed. Unfortunately, most drug research today is siloed in a way that prevents collaborative research, and if you look up the pipeline for TB drugs, it’s empty at the early clinical development stage (phase1).

That’s why MSF is calling on governments, pharmaceutical companies and researchers to come together to adequately fund the fight against DR-TB and to urgently deliver new treatments. MSF are actively seeking new ways to conduct R&D, and to ensure innovations are affordable and accessible. For example, MSF’s 3P project lays out an open collaborative approach to conducting drug development and proposes novel approaches to financing and coordinating R&D. 

With MDR-TB patients demanding change (see the TB Manifesto), it is vital that the current lack of interest and investment in TB is reversed and TB is given the priority it needs.

Further reading...

Key documents on this topic selected by Dr. Grania Bridgen include:

Global tuberculosis report 2013
K Floyd / World Health Organization 2013
This report provides a comprehensive assessment of the TB epidemic and progress in implementing and ?nancing TB prevention, care and control at global, regional and country levels using data reported by 197 countries and territor...
2013 Report on Tuberculosis Research Funding Trends, 2005–2012
M. Frick; E. Jiménez-Levi; M. Harrington (ed) / Treatment Action Group 2013
In this report Treatment Action Group (TAG) tracks, for an eight year period, annual spending on tuberculosis research and development (TB R&D) and compared investments in six areas of research with the corresponding annual fundin...
2013 Pipeline Report
P. Clayden; S. Collins; C. Daniels / Treatment Action Group 2013
This report focuses on HIV, Hepatitis C Virus (HCV), and Tuberculosis (TB) drugs, diagnostics, vaccines, preventive technologies, research toward a cure, and immune-based and gene therapies in development. A good pipeline would...
The new face of an old disease: urgent action needed to tackle global drug-resistant TB threat
Médecins Sans Frontières 2014
This MSF Crisis Alert argues that there is a global drug-resistant tuberculosis (DR-TB) crisis which demands mass mobilisation and new treatments. It argues, while the first new TB drugs in 50 years, along with developments in diagnos...
The 3P proposal to accelerate innovation and access for new treatment regimens for TB
Access to Essential Medicines Campaign, MSF 2014
The aim of the ‘3P Project’ is to rapidly deliver affordable, effective new regimens for tuberculosis (TB) through an open collaborative approach to conducting drug development and through novel approaches to financing and...