The letter below was sent from directly from MSF to numerous Ministers of Health across the EU in reaction to a Council Conclusion on innovation in antibiotics. Although MSF applauds the focus on effective antibiotics that the EU has taken under the Swedish presidency, the letter outlines recommendations for the current draft of Council Conclusion on the “Innovative incentives for effective antibiotics” (n° 16006/09) to focus and strengthen its targets. Read below for full text.
Dear Minister,
I am writing to raise important comments that we have about the draft Council Conclusion on the “Innovative incentives for effective antibiotics” (n° 16006/09) which is due to be adopted by the EU during the Council of Ministers of Health on December 1st 2009.
Médecins Sans Frontières welcomes that under the Swedish presidency, the EU has targeted antimicrobial resistance as a major priority with a focus on innovative incentives for effective antibiotics. We believe the draft Council Conclusion provides an opportunity to advance this important area of research.
The most urgent antimicrobial resistance problem our teams in the field are facing is the spread of multi-drug resistant tuberculosis (MDR TB) strains. Globally, there are an estimated half a million new MDR TB cases annually, including 50 000 cases of extensively drug-resistant tuberculosis (XDR TB). XDR TB cases have been reported from 15 EU member countries to date.1 Less than 3% of patients with MDR TB today receive adequate treatment according to WHO recommended standards.2 This represents a true public health emergency.
Available drugs to treat MDR TB are of limited efficacy, have significant toxicity and require treatment for up to two years. It is MSF’s firm view that it will not be possible to fully address this public health problem and reach global targets for treatment of MDR TB unless more effective and less toxic antibiotics, active against drug-resistant strains of TB are developed. TB should therefore be an integral part of the EU antibiotics initiative. EU interventions in TB are justified by the significance of TB both in Europe and the world.
We are concerned that there are certain omissions in the current draft Council Conclusion on the “Innovative incentives for effective antibiotics” (n° 16006/09). We urge the members of the Council to consider amending the document to include the four points outlined below.
Firstly, the Conclusion should call on the member states and the Commission to ensure that the priorities in development of new antimicrobials not only reflect the disease burden within the EU but also global disease burden. This would be part of the fulfillment of the Union’s global responsibility for health research and be consistent with the “Priority Medicines for Europe and the World” report, commissioned by the Dutch presidency in 2004, that emphasized “a clear ‘commonality of interest’ that Europe shares with the rest of the world.”3
Secondly, there is no mention of TB in the Conclusion. This is a critical omission given the urgency of the problem. Tuberculosis should be explicitly stated as part of the antimicrobial resistance initiative. The Conclusion should refer to the resolution passed by the 62nd World Health Assembly (May 2009) on prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis.
Thirdly, new approaches in tackling antimicrobial resistance should include reference to innovative mechanisms to further research and ensuring access, such as prizes. The Conclusion should refer in particular to the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, passed by the 61st World Health Assembly (May 2008).
Finally, the draft Conclusion currently allows a timeframe of two years just to devise a plan. This does not reflect the priority of the issue. A shorter time frame and specifics on the necessary financial support are needed to reflect the urgency and genuine commitment of this initiative.
The Council will meet on World AIDS Day which adds special significance to our cause as TB is the leading cause of death amongst people living with HIV/AIDS.
The EU has shown leadership in targeting antimicrobial resistance but it is important that in order for the potential of this work to be fully realized it addresses public health needs, including TB. We are happy to discuss further with you.
Yours sincerely,
Dr Tido von Schoen-Angerer
Executive Director, Campaign for Access to Essential Medicines
Médecins sans Frontières
1 http://www.who.int/tb/challenges/en/
2 62nd World Health Assembly. Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. WHA 62.15, May 2009
3 Priority Medicines for Europe and the World. World Health Organization, Geneva 2004. http://whqlibdoc.who.int/HQ/2004/WHO_EDM_PAR_2004.7.pdf