Keeping promises on TB

* MARK HARRINGTON | Thursday November 15, 2007 00:00

These people died before they could even be diagnosed, let alone treated. Since then, XDR-TB, which is extremely difficult to treat with today's antibiotics, has been detected in 41 countries, and it continues to spread.

Recently, for the first time, the world's largest tuberculosis conference was held here in South Africa. This is an acknowledgement that urgent action needs to be taken.

Tuberculosis is striking back with a vengeance.
For decades the world has ignored TB, relying on 40-year-old drugs that take months to cure disease, and an 85-year old vaccine that does not sufficiently protect beyond childhood. The most common TB diagnostic - the microscope test, introduced in 1882 - fails to detect a large percentage of cases, and more expensive tests are unavailable in many developing countries. Neglect, poorly-funded TB programmes, and lack of quality health services have fuelled the emergence of drug-resistant strains of the bacteria. TB is the leading killer of people with HIV, and TB's deadly interaction with HIV is devastating communities everywhere.

Like SARS and avian flu, the uncontrolled spread of drug-resistant TB also poses a potentially devastating threat to global health and economic growth. Only a few months ago, an international panic was created when an American lawyer boarded a plane with what was thought to be XDR-TB. The spectre of potential nightmare scenarios like these will only grow if XDR-TB is left unchecked.

Yet despite the XDR-TB threat, a new report released this week shows that worldwide, government funding for TB research actually declined last year. Between 2005 and 2006, funding from governments for TB R&D declined from US$259 million to $244 million. The United States considers drug-resistant TB to be a potent bioterror threat. Yet last year, the US National Institutes of Health, the world's largest health research investor and a leader in TB research, cut funding for TB research by $8 million. Funding from European countries was also stagnant.

The world is failing to keep its promises on TB. Last year, world leaders agreed to adopt The Global Plan to Stop TB: 2006-2015, which committed to increase funding for TB research to an average of US$900 million a year. The Global Plan was announced with enthusiasm at the World Economic Forum in Davos, endorsed by the UN General Assembly Special Session on HIV/AIDS in June 2006, embraced by the G8 in July 2006, and supported again by the World Health Assembly in May 2007. Yet the year the Global Plan was adopted, the top 40 research donors worldwide spent only $413 million on TB research - half a billion dollars less than the Global Plan's own targets.

If basic science, operational research, and a comprehensive research response to XDR-TB are factored in, Treatment Action Group estimates the total need is closer to $2 billion per year, more than four times the current amount. If the world is serious about making TB history, governments must step up to the challenge and scale up their investments in both research and implementation.

In the short-term, there is some good news, mainly from the Bill & Melinda Gates Foundation, which increased its support for TB research from $58 million to $94 million in 2006. But funding from philanthropies, while filling many current gaps and pushing a few new products through the pipeline, cannot rescue the world from the lack of sufficient public sector investment, which is responsible for a majority of TB R&D worldwide.

New money is urgently needed to develop new vaccines, drugs and diagnostics to treat TB. With drug-resistant TB emerging, decades of neglect have put us back at square one. New TB vaccines will take many years to prove their efficacy. No new drugs have been approved to treat TB in over 40 years, and there are only a handful of new drugs in development. Without more investment in basic science to understand how the TB bacterium develops, this pipeline of candidates will quickly dry up. The international response to XDR-TB will be hampered without new diagnostics to quickly detect drug-resistant TB.

We know investing in research can yield life-saving breakthroughs - like the almost 30 new anti-HIV drugs discovered and brought to market since 1987. Millions of people worldwide now benefit from these recent discoveries. But unlike HIV, the world has largely ignored TB. In the last five years, the United States has made significant contributions to global health by unveiling new initiatives to fight HIV and malaria. This type of leadership is crucial for global TB control.

To address the challenge of TB, the World Health Organisations, donor countries, scientists, and representatives from countries with high TB burdens, should immediately identify urgent TB research gaps, commit funding to fill those gaps, and determine a coordinated global TB research agenda. In the long run, the public sector must be willing to pay to expand basic TB science and develop clinical trial infrastructure in order to ensure lasting progress. The private sector must also increase its investment in TB research. We are living in a time of potentially great scientific accomplishments, but what is missing is commitment to make those advances a reality.

* Mark Harrington is the Executive Director of the Treatment Action Group, an AIDS activist group based in the United States.