Wednesday, 26 March 2014

World Tuberculosis Day 2014 passes with a glimmer of hope

Even though tuberculosis kills 1.4 million people each year it is often thought of as a disease of the past. However, it is a very present danger, and is one of the three main killer infectious diseases (along with malaria and HIV/AIDS). One reason that it has been overlooked is that its main impact is in developing countries. Tuberculosis and poverty create a vicious cycle, whereby the disease exacerbates poverty and this in turn increases the possibilities of contracting the disease.

One estimate suggests that tuberculosis will effectively rob the world’s poorest countries of an estimated US$1 to US$3 trillion over the next 10 years. This “draining” economic effect means that it is very difficult for these countries to advance and improve conditions. The World Bank has put the loss of productivity due to TB at somewhere between 4 to 7 percent of some countries' GDP. At a community level, the economic burden of illness for households has been described as catastrophic.

Given the threat posed by the disease, greater efforts are being made to rectify the problems and complacency of the past. In particular, the World TB Day initiative, held on 24 March each year, has attracted a lot of media attention. This campaign produces a range of information in different languages (Arabic, Chinese, English, French, Russian and Spanish) to maximize its global impact.

Another area where progress is needed is in the area of drug development. The track record for new anti-tuberculosis drugs has been pitiful. New advances are badly needed as drug-resistant forms of the disease are a major health problem and current therapies are not adequate to deal with the situation. As tuberculosis offers low rates of commercial return, it has been of little interest to most pharmaceutical companies. The perceived lack of interest of pharmaceutical companies to go it alone in this area has prompted the idea that R&D partnerships with the public sector and other organizations might be a better approach. For example in 2007, seven pharmaceutical companies announced that they would team up with four research institutions and work with the Bill & Melinda Gates Foundation to create a partnership called the Tuberculosis Drug Accelerator (TBDA). Since then, other companies have joined this unique partnership. The TB Alliance, established in 2000 as a not-for-profit product development partnership, has played a major role in trying to deliver innovation for this area. At present, TB Alliance and its partners manage the largest pipeline of TB drugs.

The regulatory agencies also have a role to play in ensuring that new drug development is encouraged. In Europe, there has been a welcome step forward recently, with the European Medicines Agency having recommended granting marketing authorization to three medicines for the treatment of multidrug-resistant tuberculosis. US regulators have also been actively encouraging this field, with one product having benefitted from a number of the agency’s incentives.

There is no doubt that some progress is being made in tackling the disease, but the scale of the challenge is huge. Worryingly, there are signs that tuberculosis is gaining a firm foothold in a number of major European cities. A lot more will be expected in terms of new advances by the time that World TB Day 2015 comes around.

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