After waiting months for the White House’s release of the National Action Plan for Combating Multidrug-Resistant Tuberculosis, TB advocates are asking why the plan isn’t more ambitious (considering some of the plan’s milestones are already close to being reached), and whether the Obama Administration will propose enough funding to put the plan into action. The alternative, they say, is that plan will gather dust on a shelf as did its 1992 predecessor with the same name.
These questions were raised last week after the USAID event launching the plan, which aims to initiate treatment in half of MDR-TB patients in the ten highest burden countries within the next five years. Along with strengthening international capacity for combating MDR-TB, the plan also aims to strengthen U.S. domestic capacity and reduce the number of MDR-TB cases in the U.S. by 15 percent over the same time period, as well as accelerate basic and applied tuberculosis research and development.
The last goal, however, does not include specific targets for the development of new diagnostic tools, drugs or vaccines. When asked about the lack of specific research and development targets, particularly for new drugs, Cheri Vincent of USAID said they weren’t included because “we can’t ensure a new regimen within five years because drugs need to go through clinical trials.”
Along with the urgent need to develop new drugs, Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, said there is a need to accelerate basic research on MDR-TB. “It’s embarrassing how long we’ve dealt with TB and the questions we still have about it compared to other diseases,” Fauci said. Scientists have yet to answer simple questions on TB latency and the nature of immune response to the disease, he said, and added there is a “pitiful lack of biomarkers and sensitive diagnostics.” Ideally, biomarkers for tuberculosis would be similar to the biomarker for HIV infection — the CD4 cell count, he said.
Vincent said USAID is optimistic they will meet and surpass certain milestones, and has already made progress in meeting targets thanks in part to Janssen’s bedaquiline donation program, which one year ago promised to donate 30,000 courses of the first tuberculosis drug to be developed in decades. TB advocates noted this begs the question why the plan isn’t more ambitious, if the targets set out in the plan, which Vincent said began to be developed almost a year ago, are now obsolete.
TB advocates also raised questions about adequate funding for the plan’s implementation, in light of the Obama Administration’s repeated attempts to cut USAID’s TB program over the past several years, only to be rejected by Congress. Advocates estimate that the program will require $412 million for fiscal year 2017 to meet the targets laid out in the plan.
Several audience members referenced a 1992 plan with the same name which didn’t see the light of day due to a lack of funding.
Stay tuned to Science Speaks for more analysis of the MDR-TB national action plan tomorrow.