Where's it coming from? Eh?
There is nothing xenophobic or racist in closing the US borders to prevent TB and other communicable, deadly diseases from re establishing themselves in public places including Kindergartens. Nothing.
Ratna Devi | Founder, Indian Alliance of Patient Groups
Tuberculosis tragically claimed another life in the United States this month when a man in Texas was found dead in an alley “with blood coming from his mouth.” This gruesome scene reminds us that TB is a real threat to us all.
The world’s deadliest contagious disease claimed 1.7 million lives in 2016. Nearly a quarter million of them were children with little hope of a diagnosis, let alone treatment.
Fortunately, the fight against TB is nearing a turning point. A concerted public health effort over the past two decades has saved 53 million lives. But new threats make for an uphill battle: drug-resistant strains, HIV co-infection and a growing prevalence of diabetes and smoking, which raise the chances of developing active TB.
Without urgent new measures, TB will kill 28 million people from 2015–2030. It could also inflict around $1 trillion in economic losses, according to a recent forecast.
New data from the World Health Organization paints a grim picture: last year 10 million people developed TB disease worldwide, with about 27 percent of them in India, my home country.
Prevention coverage for children in many places is abysmal. Only 11 percent of eligible kids under five receive preventive therapy in India, compared with nearly 80 percent in South Africa.
The UN convened a watershed high-level political meeting in September and member states signed a declaration to commit to addressing this global scourge. If these steps bring new attention and funding to the disease — and avoid being co-opted by ideologues — it could mark the beginning of the end of TB.
Over the summer, diplomats in New York negotiated a declaration to call on countries to give top priority to research for a new vaccine, drugs and diagnostic techniques, along with support for community-based public health programs. Such programs would include more proactive outreach efforts in the low-income populations where most TB cases occur.
This declaration would also emphasize the importance of maintaining incentives for innovation in TB drugs, including strong protections for intellectual property (IP) rights in line with international norms.
This tragic loss of life and continued suffering needs to end with concerted efforts from all of us. The National Strategic plan 2017–2025 proposes bold strategies with commensurate resources to rapidly decline TB in India by 2030 in line with the global End TB targets and Sustainable Development Goals to attain the vision of a TB-free India.
The document, however, is silent on promoting investments for new drugs or making available the newer versions for the people in India.
In Europe, the average cost of treatment for drug-susceptible TB is around $11,874, but drugs account for just $488 or 4.1 percent of the total, with the rest due to other factors including hospitalization, monitoring and administrative costs.
In India, the average cost of treating drug-susceptible TB is around $251, with drugs representing as little as $15 of this total, while recent studies found that drugs account for less than a third of Indian MDR TB treatment costs.
In South Africa, the average cost of treating multidrug-resistant (MDR) TB is $17,164 — with drugs contributing less than 5 percent.
Across low-income countries, drug-susceptible TB costs an average $258 and MDR TB an average $1,218 per patient to treat, with drugs contributing only a fraction in both cases ($49 or 19 percent in drug-susceptible cases in low-income countries).
As these examples illustrate, most of the costs associated with TB treatment are generated in other categories including hospitalization, transportation, administration and soon. Although some of this expense is unavoidable, recent studies have shown that decentralized, community-based interventions can yield significant cost savings by minimizing inpatient visits and increasing adherence to drug regimens.
In South Africa, a fully decentralized strategy using local clinics reduced the average cost of treating MDR TB to $6,749. That is 78-percent less than standard treatment in a centralized hospital context. Meanwhile, in India, a community-based model for MDR TB lowered the cost per patient 80 percent. We need new and better treatments to stop TB.
Private investment in TB research declined from $145 million in 2011 to $78.5 million in 2016, leaving U.S. government agencies responsible for the lion’s share (44 percent) of global TB drug research with $316.5 million of R&D spending that year.
While America possesses formidable research capacity, achieving the long-term goal of controlling and perhaps someday eradicating TB will require incentivizing new private sector R&D, as well as expanded funding for public-private collaboration.
Threatening to tear up patent protections through compulsory licensing can only serve to speed the current decline in private sector R&D. We need more incentives for drug companies to make the risky investments needed to find the next generation of breakthrough treatments.
Preventing tens of millions of needless deaths over the next decade will require a global public health effort even more unprecedented than the just concluded high-level political meeting.
Leaders who called for a broad-based public-private cooperation to develop powerful new drugs and a more effective vaccine, as well as a robust community-based strategy to deliver cost-effective diagnosis and treatment to the low-income populations where TB is most prevalent should now engage the stakeholders to develop country plans and measurement mechanisms.
Dr. Ratna Devi is the founder of Indian Alliance of Patient Groups.
Thank You Ratna Devi and the DC.