Ending TB

Ending TB

1. News:

U.N. will conduct the first-ever high-level meeting (HLM) on tuberculosis (TB) on 23rd september 2018, under the theme “United to end tuberculosis: An urgent global response to a global epidemic”.

2. Important facts:

• World Health Organisation( WHO)’s adopted “End TB Strategy” in 2014 aims to eliminate TB worldwide by 2035.
• Elimination of TB mean that there should be less than one case of TB for a population of 10 lakh by 2025 and 95% reduction by 2035 in the number of TB deaths  and to ensure that no family is burdened with catastrophic expenses due to TB according to the WHO.
•  United Nation ‘Political Declaration’ would galvanise the investment and action to meet this global target to eliminating TB.
• The UN declaration would also be focused sustaining and encouraging innovation against TB.

3.  About tuberculosis (TB)

•  Tuberculosis is the leading global infectious disease killer, surpassing even HIV/AIDS.
•          It is airborne and caused by bacterium named M. tuberculosis .
•         WHO reports that TB kills 1.7 million people each year and disproportionally affects poverty-stricken people.

4. Reasons for the prevalence of TB epidemic

•         Inequitable access to quality diagnosis and treatment.
•          Lack of understanding of many basic issues including the pathogenesis and natural history of TB.
•         Inadequate biomarkers and  other diagnostics that identify individuals at highest risk of progression to disease.
•         Longer timelines for trials of TB vaccines and inadequate study of drug-drug interactions .
•         The drugs used to treat TB, especially multidrug-resistant-TB, are decades old and can cause debilitating and potentially even fatal side effects ON PATIENTS.
•         Access is suboptimal for new diagnostic technologies such as GeneXpert and new drugs such as bedaquiline.
•         Incorrect drug usage and leaving TB treatment in between lead to its wide prevalence.
•         The research in the social determinants of health indicates that factors such as undernutrition, smoking, and diabetes are major driving forces behind the TB epidemic.
•         Lack of private sector participation and engagement where at least 50% cases are repo

5. Contentious issues in the  upcoming UN meeting on TB

• Exerting full rights by nations under TRIPS agreement to have accessible and generic version of TB drugs would remain a major issue during the meeting.
• The aggressive push by several countries backed by big pharma lobbies regarding cost of TB drugs (affordability)  may lead to re-negotiations by developing nations.
•   The issue of ‘de-linkage’, to separate the R&D costs from financial gains may be debated.

6. India’s case with TB

•      According to the Global TB Report 2017 released by WHO, India has the highest number of TB cases in the world and accounts for one fifth of the world’s TB burden.
•       The Indian government recently announced National Strategic Plan (NSP) to eliminate TB by 2025, well ahead of global targets.
•         It intends to increase access to improved diagnostics and treatment support, engage with the private sector and strengthen the healthcare system and TB surveillance .
•         India has also fought to retain its status as a maker and distributor of generic medicines, thereby protecting the right to health of people in developing countries.
•       Indian patent law contains important provisions that help protect and promote public health goals — for example, by overcoming bids by big pharma to evergreen patents of old drugs, through compulsorily licensing for certain drugs.
•         By permitting pre- and post-grant opposition to patents to challenge unfair parenting practices by big pharma.

7. Measures to end TB epidemic worldwide

•        Introduce new diagnostic technology and newer anti-TB drugs.
•      Rapid and effective private sector participation.
•   “The Break the Stigma campaign” and  “Zero TB Cities challenge” to raise awareness globally.·
•   Encourage research to identify biomarkers to diagnose individuals with recent infection and at highest risk of progression to disease.
• Vaccine trials need to be expedited and injectable antibiotics, needs to be replaced with oral medicines like bedaquiline and diagnostics like GeneXpert test·
•  Encourage the pharmaceutical industry to develop new innovations for the disease.
•  Generic versions of TB  vaccines need to be promoted in low-income countries.

8. This UN-HLM delivers Sustainable Development Goal 3, which seeks to ensure healthy lives and promote well-being for all.

9. However a balanced approach is  needed on patented drugs because if drug makers are unable to make returns on their investment, they may be deterred from developing the next generation of therapies that are urgently needed.