Calls for strengthened lab capacity, service delivery and better policy–while resource question looms large

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Editor’s Note: This is another dispatch from the Pacific Health Summit, filed by Christine Lubinski, director of the Center for Global Health Policy.

Following NIAID Director Anthony Fauci’s powerful call for a transformative research agenda for tuberculosis, other presenters highlighted the challenges in wooing pharmaceutical companies, biotech firms and young researchers to the field of TB, given the paucity of resources available and the challenges for industry trying to recoup investments and make a profit for shareholders.

Some argued that a research and development focus on responding to latent TB held the promise of garnering a huge world market, including wealthy countries, with one-third of the world’s population infected with latent TB.  Others identified various potential incentives that might bring more industry involvement to the table, such as donor commitments to purchase products for poor countries and marketing exclusivity commitments.

The dearth of sites available for clinical trials was identified as a significant bottleneck in evaluating current drug and vaccine candidates, while all agreed that the pipeline is far too limited. Participants said that new more potent and less toxic fixed drug combinations (FDCs) were urgently needed–along with a regulatory framework that made approval of such a product expeditious. But there was also agreement that a regimen currently in trials that would reduce treatment time from 6 to 4 months would make a real contribution. Thirty percent of patients who don’t complete treatment default between month 4 and month 6.

 Representatives from high burden TB countries—the so called BRICS, Brazil, Russia, India, China and South Africa—updated meeting participants on ongoing challenges and important progress made.

A panel of providers and activists highlighted successes on the ground. Peru’s program to combat MDR-TB, initially funded by the Gates Foundation and the Global Fund, is now funded by the country’s health ministry. But effective drugs are not always available to meet the needs of Peru’s numerous MDR-TB cases–or 71 current cases of XDR-TB.

Others spoke of treatment failure because of drug shortages and provider adherence to antiquated recommendations that call for inadequate second-line treatment regimes, do not respond to the realities of rural areas in framing minimum requirements for TB care access, or that fail to provide adequate guidance on ambulatory treatment for MDR-TB while patients die while waiting for beds in MDR-TB hospital units.

While we listened to the enormous problems and challenges in global TB, the US Congress took its first step at identifying funding for global TB when the House Foreign Operations Appropriations Subcommittee called for a $39 million increase in TB  for USAID, for a total of $202 million. That’s $29 million more than the Administration had proposed in its budget. 

The Subcommittee also allocated $700 million for the Global Fund to fight HIV/AIDS, TB and Malaria, $100 million more than the Administration request.

One couldn’t help but wonder why more high-level officials from the US government were not present at this important meeting.  The increases for TB in the opening salvo of the annual US budget deliberations were welcome, but hardly reflect the transformation so eloquently called for by Dr. Fauci and so urgently needed to reduce the human toll of this ancient and still menacing infection.  This advocate longed for the presence of Obama administration officials with policymaking authority to help transform the US response to tuberculosis.

There is a public website associated with this meeting which will hopefully serve as a resource for those unable to be here:   www.pacifichealthsummit.org

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