Underfunded and Deadly Tuberculosis Needs its Own Bill Gates

Community support workers are key in raising awareness about TB and promoting diagnosis and treatment. Credit, Busani Bafana/IPS

By Busani Bafana
BULAWAYO, Zimbabwe, Jan 7 2022 – Global efforts to end tuberculosis (TB) are futile without dedicated investment in research into the debilitating disease that is killing 4000 people a day, Stop TB Partnership warns.

“TB is a disease that is not a darling of donors and investors,” Lucica Ditiu, the Executive Director of the Stop TB Partnership, told IPS in an interview from Geneva.

“We do not have a Bill Gates that can support TB research, yet TB remains a disease of concern with deaths increasing for the first time in over a decade,” she added.

TB, a bacterial disease mainly affecting the lungs, has been around for over millennia and remains one of the top killer diseases globally. But it is preventable and curable with the right investment in diagnosis and treatment.

Ditiu attributed the rise in TB incidents to several factors; many people diagnosed and on treatment for TB have defaulted owing to the disruption of health services in the wake of the COVID-19 pandemic and global lockdown. Furthermore, many people remain undiagnosed because they have not been reached.

Dr Lucica Ditiu, Executive Director of the Stop TB Partnership. Credit: Stop TB Partnership

“Southern Africa has done a good job in respect of Zambia, Zimbabwe and South Africa as well as Rwanda in trying to disrupt as little as possible the treatment and diagnosis of people with TB,” Ditiu said. She commended awareness programmes in the media and community door-to-door campaigns to promote diagnosis and treatment.

Countries need to invest more in finding people with TB and putting them on treatment. Until you find people, you cannot put them on treatment, and this is where we are very much lagging, she said.

Ditiu fears the worst should the world fail to change the current TB transmission trend. An estimated 5.8 million people received treatment for TB in 2020; a drop of 21 percent from 2019, and more than 4 million people worldwide remain untreated. According to Stop TB Partnership, half of those untreated are likely to die from the disease.

Admitting that funding for TB has always been insufficient, Ditiu said TB was the poor cousin compared to the deep pockets for HIV and AIDS.

“In general, we have available only 30 percent of the funding needed globally. We have places that have done well in preventing TB in people living with HIV. Prevention of TB in people living with HIV is going well, especially in African countries because HIV has resources.”

According to the Stop TB Partnership, a network of international organisations established in 1998 to help end TB as a public health problem, funding for TB research and development (R&D) has remained flat since 2018.

Global funding for tuberculosis (TB) research totalled 915 million US dollars in 2020 – less than half the goal of 2 billion US dollars set forth by participating country governments at the 2018 United Nations High-Level Meeting on TB.

In 2021, TB had a funding gap of 13 billion US dollars globally, with only 5,3 billion US dollars available for its programmes. It experienced a drop in funding amounting to 500 000 US dollars in 2020 as many countries took money away from TB to respond to COVID-19.

A new report, Tuberculosis Research Funding Trends, 2005–2020 by Treatment Action Group (TAG) and the Stop TB Partnership, found that TB received less than 1 percent of the amount invested in COVID-19 Research and Development over the first 11 months of the pandemic.

“The mobilisation of over 100 billion US dollars for COVID-19 research and development in the first 11 months of the pandemic shows us just how powerful a coordinated effort against a disease can be,” noted Ditiu.

While the pandemic has shown that effective vaccines can save lives, the world is still banking on a 100-year-old vaccine, Bacillus Calmette-Guérin or BCG. However, a more effective vaccine could have higher efficacy rates, especially for adults. Why has it taken so long to develop a new, more effective TB vaccine when the health burden of TB is increasing?

“This is the drama,” Ditiu commented. “We have a vaccine for a hundred years that we know for the last 40 years does not work (effectively) except for newly-born babies, and yet we have not done much about it.”

While ongoing research on new vaccines had been slow because of poor funding, Ditiu said several potential vaccines were in the pipeline, and a vaccine could be expected by 2027.

“It takes a long time to get a vaccine. But because of COVID (we realised), it is possible to have a vaccine much quicker, and we hope to use the learnings from COVID-19 to get a TB vaccine,” Ditiu told IPS.

Tuberculosis vaccine research has been slowed by chronic underfunding with only one moderately effective century-old TB vaccine, compared to over 20 COVID-19 vaccines.

“What’s enabled the development of dozens of COVID-19 vaccines in less than a year has essentially been money,” noted Austin Aurinze Obiefuna, Executive Director of the Afro Global Health Alliance and incoming Vice-Chair of the Stop TB Partnership Board.

“I think that the same enormous amount of funding should be applied with equal vigour to the development of TB vaccines. But that simply doesn’t seem to be happening.”

According to the Stop TB Partnership, making much-needed progress against TB demands investment that matches the threat of the disease around the world. This includes a commitment to rectify the inadequate funding of the past. Over the next two years, 10 billion US dollars are needed to close the tuberculosis R&D funding gap.

“Wealthy countries need to step up and put more money into correcting global health inequalities, which COVID-19 vaccine allocation inequities laid bare,” urged Mark Harrington, Executive Director of TAG, an independent activist, and community-based research and policy think tank.

“COVID-19 made more people around the world aware of the importance of R&D spending than ever before. Now is the time to finally start making investments ambitious enough to end TB for good.”


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Activism will be Key to Overcoming the Covid-19 Crisis

Protest sign, London. Credit: People’s Vaccine Alliance

By Ben Phillips
ROME, Jan 7 2022 – As the Omicron surge overwhelms the world, it is clear to people everywhere that the actions which leaders so far have taken in response to the Covid-19 crisis have not been sufficient to overcome it.

We are not beating Covid. It looks rather like Covid is beating us. What is to be done?

Crucially, they are two key dimensions to what is needed now which, though related, are distinct. The first dimension is what policies are required to get us out of the crisis. The second dimension is how to get those policies put into place.

In other words, the first key question is “what do leaders need to do?”, and the second key question is “how do we make them do it?”

On the first question, the world is fortunate that we are not short of excellent public health expertise. Whilst there are no quick fixes, the contours of the policies required are not a mystery, and have been set out, to leaders and to media, repeatedly, by the World Health Organisation, by leading academics, and by health practitioners.

They come down essentially to this: in a pandemic emergency, leaders need to deploy the whole range of tools that have been shown to help. The key here is the whole range.

Importantly, in terms of how these approaches can be realized, this requires that they are realized for the whole world. Until they do, none of us will get out of the crisis. When Desmond Tutu said that “I am because you are, I am because we are”, that was not only true ethically, but, it turns out, true epidemiologically too.

The approaches required include vaccines, treatments, and also, as the WHO’s Peter Singer has noted, “public health measures that encourage spending time outdoors, physical distancing, wearing masks, rapid testing, limiting gatherings and staying home when sick”.

None of these alone is enough. Any approach that only does one of these, however well, would fail – all of them are needed, together.

It requires the application of the whole range of policy tools. For example, rich countries, and Foundations based in rich countries, have emphasized the importance of sharing doses as a solution (even whilst they have comprehensively failed to deliver on their promises to do so).

In contrast, developing countries, the World Health Organisation and civil society have all highlighted that sharing doses alone cannot ensure enough for everyone, and that it is essential also to share the technology so that multiple producers across the world can simultaneously manufacture enough to vaccinate the world.

This requires rapid agreement and implementation of the TRIPS Waiver proposed by South Africa and India at the WTO, and it also requires that rich country governments use their huge leverage (as procurers, investors and regulators) over the companies they host to make them share knowledge, know-how and material. Furthermore, this requirement to share Covid technologies needs to apply to vaccines, medicines and diagnostics.

As public health professors Madhukar Pai of McGill and Manu Prakash of Stanford have noted, “Science has delivered many tools that work against Covid-19. But equitable distribution of these tools is where we are failing.

If we can find a way to share effective tools equitably and increase their production across the world, then we have a real shot at ending this pandemic.

If we hoard these tools, block TRIPS waiver, and think we can boost our way out of this pandemic in the global North, we will begin 2023 by playing whack-a-mole with the rho, sigma, tau or Omega variants.”

The challenge then, is not that we don’t know what leaders need to do. The challenge is that they are not doing it. We like to believe that our leaders are led by the evidence. But evidence alone is not enough.

The brilliant and essential reports of scientists will not be enough to shift the much harsher world of political interests. Getting leaders to do what is needed to overcome the Covid-19 crisis – in particular getting leaders to force the big pharmaceutical companies to share the rights and recipes for the vaccines, therapeutics and diagnostics so the world can produce the billions needed – will depend on pressure from ordinary people.

This is not a new lesson. We saw it in the late 1990s and early 2000s with antiretrovirals for HIV. Then, as now, a monopoly hold on production was preventing people in developing countries from accessing life-saving help.

Then, as now, the big pharmaceutical companies worked aggressively to block other producers from manufacturing what would save millions of lives. Then, as now, rich country governments sided with the big pharmaceutical companies. Twelve million people died. Finally, massive global public pressure, together with assertive action by developing countries, ensured that production was opened up and lives could be saved.

It was not a coincidence that when the Covid-19 crisis erupted the first groups to call for the sharing of medical technologies, and to start to organise for it, were groups of people living with HIV. They are the heart of the movement for a People’s Vaccine because, from painful experience, they know what it takes. Health, like justice, is never given; it is only ever won.

Some people are inspired by activism. Others, understandably, just want to get on with their lives. Activism feels like another burden. They’re ready to do their part by wearing a mask when available and getting vaccinated when offered. But they want to leave the leadership to our leaders.

The thing is, that’s not enough. Our leaders are not leading. They are not doing all they can to end the crisis. They are not forcing the big pharmaceutical companies to share technologies so that enough can be produced. They are not ensuring access to health care as right. They are not protecting the vulnerable from the shock of the crisis.

The past two years can best be summed up like this: the science is working, but the politics is failing.

It is only through bold action by political leaders that the Covid-19 crisis will be ended. It is only through people’s organising that we’ll make leaders take that bold action. As the great novelist Alice Walker once put it so powerfully, “activism is the rent we pay for living on the planet”.

Ben Phillips is the author of ‘How to Fight Inequality’ and an advisor to the United Nations, governments and civil society organisations (CSOs).


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