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

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. 

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: