Feature story |

Overcoming the gaps in TB research. Do we need to rewrite the rules?

A six or eight months long treatment course relying on old drugs, a two-year long second-line treatment of expensive, toxic drugs that are difficult to procure and often don't work, the emergence of deadly strains of XDR-TB, the absence of accurate easy-touse tests to detect infection, let alone drug sensitivity - the list of gaps in tuberculosis research and development can seem terrifyingly daunting.

At a 2007 symposium convened by MSF on tuberculosis drug R&D needs, more than 100 experts from around the world including drug developers, clinical researchers, health professionals, policy makers, donors and activists recognized that “the lack of TB drug development is a result of the failure of the current profit-driven drug research and development model.” Put more simply, that means that to plug the gaps in TB research, you need to rewrite the rules that govern the way essential medical R&D is done today. TB has suffered from decades of neglect from pharmaceutical companies, researchers and policy makers, because with until recently, it offered no lucrative rewards and incentives for investment into R&D.

Looking for an Answer

The participants of the MSF symposium point to talks going on now at the UN for an answer to this problem: “With respect to TB drug development, participants of the New York symposium support current discussion at the WHO for a treaty on essential health R&D that addresses the question of who pays for essential medical R&D and de-links incentives from drug prices, instead rewarding the impact of inventions according to health care outcomes.”

Talks organised by the WHO have been ongoing as Ministers of Health from around the world to negotiate a plan of action and strategy to address the gaps in essential R&D and access to the medicines, diagnostics and vaccines of today and tomorrow. In other words, how the R&D rules might be re-written so that diseases that disproportionally affect developing countries, (and therefore carry little financial incentives for the pharmaceutical industry to address), can be prioritised.

Changing the Paradigm

The Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (or IGWG, to give the meeting its proper name), is looking at other potential areas of action - such as addressing the funding gap for R&D (the annual shortfall for TB was recently estimated US$800 million a year); coming up with new funding mechanisms such as an international R&D treaty, that provide regular and sustainable financing for R&D; overcoming the lack of access to libraries to screen potential compounds held by pharmaceutical companies for action against tuberculosis or other diseases; improving regulatory processes to approve health technologies for neglected diseases; or managing intellectual property in innovative ways, such as making use of patent pools to facilitate upstream and downstream research as well as to improve access to medicines.

If successful, the IGWG could help bring about an end to the chronic neglect of R&D into diseases that predominantly affect developing countries - research that, so long as access to medicines can also be ensured, would eventually provide solutions for the daunting obstacles faced by doctors to effectively detect and treat tuberculosis today. Read more.