Kill the Killer

Multidrug-resistant tuberculosis is on the rise around the world and becoming a public health threat. Yet it is still not getting the attention it deserves.

Tuberculosis is an ancient illness, but it is the world’s second leading infectious killer today. We may remember from our history and literature classes how many famous people died of this disease: Anton Chekhov, Franz Kafka, D.H. Lawrence. In the 20th century, no less than four Nobel Prize Laureates were linked to the discovery of and treatments for TB, but the disease remains a very present challenge – nowhere more than in China, India, Russia, and South Africa.

Modern-day tuberculosis paint a worrisome picture. Nine million people fell ill with TB in 2013 (the latest available verified data so far) and 1.5 million people died from the disease. Equally alarming, 480,000 people developed a strain of tuberculosis that no longer responds to the two most powerful first line anti-TB drugs, making their illness incredibly difficult to cure. Every one of the BRICS is a High Burden Country for tuberculosis, and 60% of these multidrug-resistant tuberculosis (MDR-TB) cases are found in the five BRICS countries.

Essentially, drug resistance arises from weak national TB control programs: due to the improper use of antibiotics, counterfeit and substandard medicines, and failure to ensure patients complete the lengthy course of their TB treatment. One in five people that fail treatment for tuberculosis go on to develop the mutated, drug-resistant infection, and less than half of these patients will be cured of the fatal disease.

The spread of MDR-TB has been propagated by many different causes. In Russia, for example, overcrowded prisons became ‘hot-spots’ of MDR-TB following the collapse of the Soviet Union. In India, inadequate national detection and treatment programs allowed transmission of MDR-TB to rise to crisis levels. In South Africa, co-infection with HIV expedited the transmission of MDR-TB and its emerging and more deadly counterpart, extensively drug resistant tuberculosis (XDR-TB).

No country can afford to be complacent about MDR-TB. Just like TB, it spreads through the air – on a bus, on a metro, or an airplane. Anyone can get infected, and in today’s connected world, MRD-TB knows no borders.

Fostering local solutions

While there is no one method to control the global burden of MDR-TB, the pharmaceutical industry has found technology transfer to be a valuable tool to supply high quality treatments where they are most needed.

Many pharmaceutical companies that are members of the International Federation of Pharmaceutical Manufactures & Associations (IFPMA) collaborate with partner pharmaceutical manufacturers in the BRICS, sharing scientific knowledge and intellectual property and strengthening human resource capacities for the production of medicines and vaccines. Indeed, today I count over 40 partnerships to increase the availability of treatments in BRICS countries in such a manner.

No country can afford to be complacent about MDR-TB. Just like TB, it spreads through the air – on a bus, on a metro, or an airplane. Anyone can get infected, and in today’s connected world, MRD-TB knows no borders

As an excellent example, following a decade of exchanged scientific knowhow with Eli Lilly and Company, the Russian pharmaceutical company JSC Biocom received the country’s first WHO prequalification for a key drug that exists to treat MDR-TB. Today, thanks to this qualification, Biocom can supply any country in the world with the highest quality medicines needed for MDR-TB, and similar programs are being carried out with generics companies in China, India, and South Africa.

IFPMA member companies are currently engaged in dozens of other technology transfers to scale-up local manufacturing capabilities for HIV/AIDS antiretroviral drugs, influenza, meningitis vaccines, and treatments for neglected tropical diseases. But a technology transfer is much more than simply handing over technology and walking away. It entails building a long-term and trusting relationship, and we have found success depends heavily on the following prerequisites:

•A viable and accessible local market;
•Political stability and transparent economic governance;
•Appropriate capital markets;
•An innovation-friendly environment with sound intellectual property rights;
•Proper access to information;
•A skilled workforce;
•Clear economic development priorities.

Governments in high-income countries must increase aid funding for health and healthcare as a platform for economic development. Building upon this, governments in low- and middle-income countries must support the development of their national private sectors and implement a welcoming environment for global partner firms.

Technology transfer can be an important tool to increase access to medicines where they are most needed, but no one would deny that the best strategy to control MDR-TB is the quality treatment of people with drug-susceptible tuberculosis.

IFPMA companies are therefore working to combat TB from other angles. They collaborate with international researchers to leverage expertise and develop new medicines to accelerate the TB and MDR-TB treatment period so that it is less difficult for patients to complete their regimen. For new medicines and vaccines, the R&D pipeline looks promising, with three new candidates in the final phases of testing and the hopes for breakthrough treatments within this decade. The companies also work with local governments, NGOs, and hospitals – sometimes even door-to-door – to quickly identify, diagnose, and cure a patient of tuberculosis.

It has been over a century since Dr. Robert Koch announced the discovery of the TB bacillus that causes tuberculosis in 1882. As each individual country and the global health community as a whole still struggles to keep this disease under control, it is evident that the elimination of tuberculosis cannot be undertaken by any one person, organization, or government alone. Nobody should stand by — now is the time for action and scaled-up collaboration across all sectors. Only then can we turn the tide against this disease.

Mario Ottiglio is Director of Public Affairs and Global Health Policy at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). With members across the globe and a secretariat based in Geneva, Switzerland, the IFPMA represents the research-based pharmaceutical industry, including the biotechnology and vaccine sectors.

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