Even though one third of the global population have the microbes that cause tuberculosis (TB), pharmaceutical companies still have little incentive to produce the drugs that can combat the deadly but curable disease.
Speaking at the European Parliament on Wednesday (21 January) Dr Lucica Ditiu, executive secretary of Stop TB Partnership, an international body coordinating the fight against tuberculosis among government bodies, donors and NGOs, underlined the huge global health burden of tuberculosis.
Latent TB in focus
Tuberculosis is a widespread, and in many cases fatal, infectious disease which typically attacks the lungs, but which can also affect other parts of the body. It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air.
But most people infected do not have symptoms, in which case it is referred to as latent tuberculosis. About one in ten latent infections eventually become active which, if left untreated, is fatal for more than 50% of those infected.
“According to the World Health Organisation, 2 billion people, or one-third of the global population, are infected with tuberculosis bacilli, the microbes that cause TB,” Ditiu said. “So it’s a huge number and we cannot stand passive and just look at it. The problem we have is that consistently over the years, people have not been diagnosed, treated or received proper follow-up and God knows what kind of treatment they take.”
European officials dealing with the disease reminded that tuberculosis treatment are costly and that there has been a global supply problem in the past.
“I need to remind you that there is a patent problem because these drugs are no longer protected by patents,” said Walter Seidel, an official who leads the unit overseeing education, health, research and culture at the European Commission’s development cooperation department (DG Devco).
“Some of the drugs are also difficult to produce as the technology is very demanding, but there is also other aspect,” Seidel said. “One in particular is important for tuberculosis: It has been a disease of the poor and the poor don’t have the purchasing power and there is little market incentive to produce drugs for tuberculosis. It’s also a highly regulated market which makes it less attractive for producers.”
Ditiu disagreed, saying everyone is at risk of getting TB. “Unfortunately, we can’t choose the air we breathe and tuberculosis spreads through the air. It’s a cross-border disease,” she said. “It’s true that it’s a disease of the poor, but I would also add that it’s actually a disease of everyone, and we even call London the capital of TB in Europe, because London has a huge and increasing problem with TB cases.”
Iain Richardson, senior director of manufacturing at the pharmaceutical company Eli Lilly, said his company did have a programme focusing on developing drugs for tuberculosis, but that the company decided not to remain in the business because of basic supply and demand problems.
“For many years we gave subsidies and our goal became to find partners that could carry forward a sustainable business,” Richardson said.
British MEP Nirj Deva, member of the European Conservatives and Reformist (ECR) group, called on developing countries to sustain local production of tuberculosis drugs.
“Small and medium size companies, as well as micro-sized companies, form the very platform of our free-market economy, but we need an increased domestic production. We need an integrated local-level approach to build sustainable production driving down the cost of medicines while increasing their availability in the area where they are needed the most,” Deva said.
He stated that there are, however, challenges such as a lack of facilities, a shortage of skilled labour and market barriers.
“SMEs in developing countries often face much heavier regulatory burdens than in the EU. In developing countries, they often don’t have data protection, and creating a business-friendly environment and bringing SMEs into the formal economy and keeping them there to succeed must be as much as a priority as cutting red tape,” Deva said.
Tuberculosis (TB) and multi drug-resistant tuberculosis (MDR-TB) are currently experiencing a dangerous upsurge across Europe.
The World Health Organisation (WHO) has warned about a rise in drug-resistant tuberculosis in Eastern Europe and former Soviet states.
But the public health crisis is not receiving much attention, health experts say, especially when the disease is combined with HIV/AIDS.
In 2013, 1.1 million people living with HIV developed TB. Although TB is entirely preventable and curable, it is the most common disease among people living with HIV, including those undergoing antiretroviral therapy.
It is also the leading cause of death among people living with HIV, with 360,000 estimated deaths annually.
2015: European year of Development Cooperation
- DG Health and Food Safety: Tuberculosis
- DG Research & Innovation: Tuberculosis
- DG International Cooperation and Development: Health policy
NGOs and aid organisations
- EurActiv France: La lutte contre la tuberculose achoppe sur le coût des traitements