Funding levels for tuberculosis (TB) research and development (R &D) fell by 0.3% in 2010 compared to 2009, according to new data released by the Treatment Action Group (TAG) and the Stop TB Partnership in the annual Report on Tuberculosis Research Funding Trends. This amount is less than one-third of the USD 2 billion annual target the Stop TB Partnership estimates is needed to provide new interventions to eliminate TB.
According to the report, the world spent only USD 617 million in TB R&D in 2010 compared to USD 619.2 million in 2009. In 2010, there were 8.8 million (range, 8.5-9.2 million) new cases of TB, 1.1 million (range, 0.9-1.2 million) deaths from TB among HIV-negative people. The decrease in funding (which has not been adjusted for the effect of inflation) is the first time TAG has documented no growth since it began tracking TB research investments in 2005.
“With current levels of funding it will be impossible to meet the research targets of the Global Plan to Stop TB 2011-2015,” said Dr. Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “This is a completely unacceptable situation, because those targets are, I would dare to say, even modest. Where is the funding to push ahead research for a point-of-care diagnostic test accessible to all, new drugs for a shorter treatment time and a fully effective vaccine?”
For the sixth consecutive year, R&D for TB treatment was the most well-funded research area—growing 19% from USD 192 million to USD 227 million. However, this is just 31% of the USD 740 million annual Global Plan target for TB treatment research.
The report also documents significant funding declines in basic science and vaccines research, which dropped 27% and 29% respectively. “The decline in basic science funding is worrisome as this research area offers fundamental knowledge that can help accelerate innovation in drugs, diagnostics and vaccines development,” said TAG’s TB/HIV project director, Javid Syed. “We urge policymakers, researchers and activists to close these funding gaps and commit to eliminating TB.”
TB and HIV activists expressed anger about the low levels of TB funding and the numbers of people being placed on multidrug-resistant TB treatment globally, at a symposium hosted by TAG at the 42nd Union World Lung Health Conference held in Lille, France, last week.
The Green Light Committee (GLC), the World Health Organisation (WHO) and the Stop TB Partnership’s initiative to support countries to manage multidrug-resistant TB, has approved the treatment of 40,000 patients with MDR-TB, but only 10,742 have been treated so far, according to Caroline Bogren of the Global Drug Facility (GDF), through which all second-line TB drugs are procured for country programmes.
According to Brogen, the reason for the low number of people on treatment is because of the high price of second-line TB drugs. “It is a catch-22. The price of the drugs will not go down unless the demand for quality-assured TB drugs increases and programmes do not want to put people onto expensive drugs.”
Bactrin Killingo of the International Treatment Preparedness Coalition (ITPC) responded: “I think it’s time we get very angry here. We know that pharmaceuticals play games. An increase in demand cannot be the only thing that will drive prices down.”
“We are stuck in a logic of thinking how can we pay this bill. Donors are keeping us hostage. We need to rethink how we influence manufacturers such as working with public manufacturers in countries like South Africa, China and India, since these drugs are no longer under patent,” said Ezio Santos-Filho, an HIV activist from Brazil.
“This drug issue has been going on for more than five years. We know how to set up a DR TB programme. PIH and Médecins sans Frontières (MSF/Doctors without Borders) have numerous projects and Nepal started a programme without help,” said Salmaan Keshavjee from Partners in Health (PIH).
“We should say to UNITAID (who fund the GDF drugs) that if they give us the money, we will treat people, instead of going through the WHO to ask for permission,” he continued. “We do not do this for any other disease. We should cut the crap and treat people or else we can come back here next year and listen to the same crap”. Twelve of the 23 drugs available only have one quality-assured manufacturer. Quality assurance ensures that the drugs are safe and efficacious.
“TB patients and activists should be given treatment literacy as to why it is important that they only take quality-assured drugs, like we did for HIV. That way the demand will come from the ground and the market for drugs of unknown quality will be killed,” said Wim Vandevelde of the European AIDS Treatment Group (EATG).
According to the World Health Organisation (WHO), less than 1% of the world's drug-resistant TB patients have been enrolled in programmes that provide internationally quality-assured treatment.