Willo Brock: Companies think in terms of markets and not in terms of scale. Millions of people affected with TB does not mean a huge potential market for them. TB predominantly hits poor people and poor communities and the private sector does not view this as a place where they can make money. That is where organisations like TB Alliance come into play to leverage partnerships, bring public and private sector together and mobilise resources and then have products that are affordable and universally accessible to all those patients who need them.
CNS: Even though the need for new and better diagnostics and treatment for TB is growing why is TB research an development so under- funded?
Willo Brock: Globally, for the high income countries it is about 'out of sight, out of mind'. They have a much less problem of TB at a much smaller scale. So they do not feel the need to invest in the interest of their own people. If we look at the BRICS countries-the emerging economies like Brazil, India, South Africa, Russia, China- they have almost 60% of the world's MDR-TB. Yet they are spending less than 5% of their research money on TB R&D. They have to be better explained the urgency of the problem - that TB is a global health crisis and that they will have to increase their investment. Unlike most other diseases, TB anywhere is TB everywhere. Unless eradicated globally, TB will be a problem as long as people breathe. The recent UN HLM on TB has forced the heads of states to turn their attention to TB and the disease is now likely to get the recognition and urgent action it deserves.
CNS: What innovative and sustained financing mechanisms can help to fully fund the fight against TB, including R&D?
Willo Brock: First and foremost, every country must commit a fair share of their investment for innovation. We cannot rely only on high income countries to fund. The resolution adopted at UNHLM should have that exact phrasing. A country like India, for instance, has invested only 36% of its fair share in terms of its TB burden. Secondly, we have to hold our leaders to account. TB has been there for over 5000 thousand years. Why have heads of states not been asked before to commit to step up investments? While Ministers of Health are convinced as they understand the problem, but they need the help of Ministers of Finance and the heads of states to agree to step up investment in TB for the sake of the people. So holding the heads of state to account is very important and an essential part of the solution to the puzzle called TB.
CNS: There is an increasing recognition that health security is critical for achieving SDGs. Is more attention to UHC and other health issues a threat or an opportunity for sustained financing for TB?
Willo Brock: I firmly believe that it is an opportunity. Expanding the sphere of assistance to people and connecting them to universal healthcare, will also increase their access to TB services. So increasing universal health coverage (UHC) is an important element of delivering TB treatment to everyone around the world. At the same time when countries invest in TB as a disease, they reduce the financial burden of their healthcare system. For instance, at the moment MDR-TB costs about 100 times more to treat than drug susceptible TB (DS-TB). So when we have new drugs to treat patients with MDR-TB, it is going to be much cheaper for everyone to get access to them. Also, the risk associated with TB (especially MDR-TB) as an infectious disease is one of the pillars of what is considered global health security threat. With new treatments coming up and being available for MDR-TB, we can bring that threat down. We can therefore say that these 3 issues - TB, global health security and universal health coverage - are inextricably linked and should be taken care of together and not as separate issues.
The first-ever UNHLM on TB was a landmark opportunity to marshal political will and make the UN member states step up the fight against TB. An important element of this summit's resolution was that we can defeat antimicrobial resistance and TB if we close the funding gap for innovation. And hopefully this would be for everyone. So equitable approaches, for securing universal access to new drugs and diagnostics and vaccines, are essential. Patchwork national level solutions are slowing down the fight against TB. To address and solve the problem of TB, countries will have to work together, collaborate cross border globally and not look at TB as just a domestic issue."
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