Examining rising rates of drug resistance accompanied by high rates of mortality that take a toll on the country’s most productive members, a Lancet article published online Friday highlights an imperative need for new drug treatments, along with more effective use of resources and policy to limit the spread of disease, The article, Long-term outcomes of patients with extensively drug-resistant tuberculosis in South Africa: a cohort study, details a follow-up of 107 patients diagnosed with XDR tuberculosis between August 2002 and February 2008. Among patients with HIV, those on antiretroviral treatment had a better chance of surviving, the study found. The study also found that by five years 78 of the patients — 73 percent — had died. During that time, 45 patients were discharged from hospitals, 19 of whom had not been effectively treated. Those patients had a median survival of roughly a year and a half after being discharged. In the meantime, they were likely to transmit disease, authors noted.
As drug resistance spreads, its cost will quickly become unsupportable, the authors say, pointing to 2010 data showing that while just 3 percent of tuberculosis cases in South Africa were drug-resistant, they came with a cost of nearly 45 percent of the nation’s TB program budget. In addition to concluding that the long-term data “underscore the urgent need for testing of new combined regimens for XDR tuberculosis,” along with the need for facilities for patients to limit the spread of disease, the authors also call for attention to poverty, overcrowding, to HIV prevention and treatment, and to stronger national TB programming.
By coincidence, the same day the article calling urgently for new medicines was published, a campaign by pharmaceutical industry leaders described here on Friday was set to begin. By coincidence also, the “urgency” of the campaign has been cited. There the similarities diverge completely. The campaign, to launch a challenge to South Africa’s proposed Intellectual Property policy “led by a visible South African” but “directed by staff from [the U.S.-based] Public Affairs Engagement” PR and lobbying firm was intended to stop an effort to address extended drug patents that policy makers had determined were making essential medicines unaffordable. On Friday, as Science Speaks and others sought comment, PAE denied that the pharmaceutical industry organizations named in the plan supported it. One was IPASA (Innovative Pharmaceutical Association South Africa) which said it had “rejected” the campaign. But an email by Merck official Michael Azrak, linked to by Knowledge Ecology International begins with the hope that all the pharamaceutical company officials on the recipient list have enjoyed “a well-earned rest,” and a look forward to “a stronger IPASA in 2014.” It then goes on to describe the proposed PAE campaign to “send the message that [South Africa’s proposed Intellectual Property] policy threatens continued investment . . .”, its cost ($450,000 of which the U.S.-based PhRMA would pay $350,000) and to say “I’m sure you can sense my urgency . . .”
Same urgency, different goals.
South Africa’s Treatment Action Campaign, whose goals are targeted by the plan, and spoke up against it last week, has issued a statement asking the pharmaceutical companies involved to clarify their involvement.