Drug-Resistant Tuberculosis: A Story of Promise

“TB is the child of poverty—and also its parent and provider”

Archbishop Desmond Tutu

It can be easy to overlook that certain diseases are curable, when their disproportionately high prevalence and incidence rates suggest otherwise. Tuberculosis is one of those diseases; under-represented, and insufficiently supported, yet still it affects billions of people and animals worldwide, killing 1.45 million people each year.

8.8 million new cases of TB occur annually. The majority of these arise in low-income countries which lack access to necessary health services and treatment. As such delays in diagnosis, poor nutrition, living conditions and insufficient access to clean water and sanitation perpetuate the cycle of disease and poverty.

On Thursday March 6^th, the Irish Forum for Global Health, with The Royal College of Physicians and Irish Aid, co-hosted a lecture and short film event: “New Drugs for TB treatment: the next breakthrough in global TB control”. The auditorium at RCPI was filled with people from all backgrounds; medical practitioners, researchers, development professionals, academics and students alike.

The evening began with a short film by Médecins sans Frontières: “The Final Frontier: Treating DR-TB” which spoke to the concerted efforts taking place in the field, around the world, towards the battle against fast developing drug-resistant forms of tuberculosis. MSF is currently working in 16 countries to reduce the burden of DR-TB, and demonstrating signs of progress towards increased access to treatment, improved diagnostics, and growing awareness.

The event really kicked off when Dr. Mel Spigelman, CEO of the Global Alliance for TB Drug Development, took to the stage to deliver his lecture, “Technological Leapfrogging: A TB Imperative”. Eagerly, he focused on the promise of innovative drug research and development strategies for the next line of defence against TB.

Approximately 5% (440,000) of new cases each year are classified as being multi-drug resistant forms of the disease (DR-TB). This means that they cannot be treated by two of the primary antibiotics normally used to treat TB. New forms of extensively drug resistant TB (XDR-TB) have developed, on which both first and second line drugs have no effect. With high costs of medicines, limited-availability, high risk of adverse side effects for second-line drugs and inadequate support for medical regimens resulting in poor drug adherence, access to treatment is meagre and the quality of life for these patients is bleak. In many places around the world, TB is still a death sentence.

Fortunately, the paradigm is shifting in the world of TB drug development and research, substantially speeding up the process of clinical trials and increasing the number of viable combination drug therapies. Now the world’s leading pharmaceutical developers and researchers are collaborating with civil society organisations and philanthropic initiatives to establish entirely new drug regimens for DR-TB and XDR-TB patients. The Critical Path to TB Regimens Initiative is an example of this work, established in 2010 by the TB alliance in collaboration with the Bill & Melinda Gates Foundation and the Critical Path Institute.

“This type of work is criminal not to do”, said Dr. Spigelman emphatically.

Currently, there are 9 novel TB drug candidates in the clinical stages of development.

TB is very much a curable disease, and the opportunity for ensuring meaningful treatment for DR- and XDR-TB is very much attainable.

-Bianca van Bavel