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Closing the TB Funding Gap

It has been 25 years since tuberculosis was declared a global-health emergency. But while world leaders generally agree on the need to invest in solutions, surprisingly few new TB medicines are being developed.

NEW YORK – In the 25 years since tuberculosis (TB) was declared a global-health emergency, policymakers and health-care professionals have devoted considerable time discussing ways to eliminate it. Over the last two years alone, they have held talks in Moscow, Brussels, New Delhi, and, most recently, in September at the United Nations General Assembly in New York, where they convened for the first-ever high-level meeting on TB containment.

But while leaders generally agree on the need to invest in solutions, we have surprisingly few TB medicines to show for our quarter-century of effort. The 250 million people who have been infected since 1993 – and the millions who have died – deserved better.

TB is the world’s deadliest infection, and it has been with us for a very long time. Researchers theorize that humans first acquired TB in Africa about 5,000 years ago, and that the disease then swiftly spread along trade routes to nearly every corner of the globe. Today, TB is among the world’s leading causes of death, killing approximately 1.6 million people in 2017, which was only slightly fewer than the year before. But the effectiveness of TB treatments is declining, raising concerns that drug-resistant strains are becoming more virulent.

Given its prevalence and seriousness, TB is not purely a medical problem. The disease perpetuates poverty in developing countries, because patients and their families must routinely spend up to half of their income buying medicines and managing care. And yet, with drug-resistant forms of TB spreading, these expenditures do not always yield results. By 2050, drug‐resistant TB could cost the global economy as much as $16.7 trillion in medical expenses and lost wages – roughly the equivalent of the European Union’s entire economic output.

To be sure, the world can still win the war on TB. Researchers are closing in on more effective drug regimens, better diagnostics tools, and viable vaccines. Still, we cannot get over the finish line without a significant increase in research and development spending.

According to the World Health Organization, the annual funding deficit for TB research and development is more than $1.3 billion, a shortfall that is exacerbated by a lack of market incentives within the pharmaceutical industry. Despite TB’s global reach, two-thirds of new cases in 2017 occurred in just eight countries – India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. With drug makers apparently unwilling or unable to fund development costs unilaterally, rich and poor countries must collaborate to fill the gap.

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The R&D burden must be shared among the public and private sectors, and resulting treatments must be universally adopted and available. The goal should be to ensure that medicines are accessible and affordable for anyone who needs them; this includes high-risk populations such as health-care workers, as well as people living with HIV/AIDS, for whom TB is a leading cause of death.

The high-level meeting in September was meant to galvanize the world’s TB-eradication efforts. Unfortunately, the rare political unity in the lead-up to the discussion was overshadowed by a debate about drug makers’ intellectual-property rights. While the declaration endorsed at the end of the UN meeting did offer a compromise, the quandary remains: how can we guarantee access to medications – especially for the poorest patients – while maintaining funding streams for pharmaceutical R&D?

Patients’ needs must always be emphasized. But we cannot simply ignore the role that intellectual property plays in the creation of new treatments. To strike the right balance with TB, the international community must recommit to R&D initiatives by showing the financial leadership agreed upon in September. In the best-case scenario, that agreement will supplement the so-called product development partnerships that have already helped tackle many neglected diseases, including TB.

Last year, an estimated 3.6 million people infected with TB were unable to access treatment, a staggering gap in coverage that must be quickly closed. The longer we wait to increase R&D funding and strengthen collaboration on treatment, the higher TB’s death toll will climb. With so many lives at stake, the time for talking is over.

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