World TB Day: Canada needs to invest in tools that will save lives

By Adam Houston, Medical Policy and Advocacy Officer in MSF Canada

In 2019, the infectious disease that killed the most people worldwide was tuberculosis (TB). In 2020, of course, COVID-19 assumed that mantle. However, that same year, with health services disrupted by COVID-19, the number of deaths from TB actually increased as well for the first time in years — a further setback to the global commitment to end the global TB epidemic by 2030.  Nonetheless, TB continues to receive but a fraction of the attention directed at COVID-19.

Doctors Without Border/Médecins Sans Frontières (MSF) treats TB patients all over the globe, and is the largest non-governmental provider of TB care in the world. In Ukraine, MSF was recently forced to halt a drug-resistant TB project in the Zhytomyr region, and is extremely concerned that continued fighting will severely limit people’s ability to seek medical care – MSF teams made sure that all of our TB patients have at least one month of treatment. There is a real risk that disrupting treatment and access to care will exacerbate what was already a serious public health concern. Meanwhile, in Central African Republic, access to key TB drugs is often interrupted by violence, in a country where access to healthcare is already limited as a result of ongoing conflict. TB is frequently linked to HIV throughout MSF’s projects around the world, because HIV and TB coinfection is common, particularly among people living with HIV who do not have access to effective HIV treatment and care. TB is also frequently connected with poverty, lack of access to nutritious food and many of the other serious systemic issues MSF encounters in humanitarian settings.

One crucial issue facing the TB response is the need for better tools. In the past half century, only three new drugs (bedaquiline, delamanid, pretomanid) have been developed. A recent report by Treatment Action Group and the Stop TB Partnership highlights how TB research remains drastically underfunded.

 Similarly, at a time when dozens of COVID-19 vaccines have been developed and approved around the world in under three years, providing a remarkable demonstration of what providing sufficient support for R&D can do, the only available vaccine for TB, the BCG vaccine, turns 101 years old this year. There are people working on developing a better vaccine for tuberculosis, including Canadian researchers at McMaster University. However, Canada is among the many countries that are not meeting global targets for contributing to TB research.

TB research, at home and abroad, urgently requires more attention. The pharmaceutical industry displays little interest in a disease that affects millions of people each year. If they are not willing to step up to support the innovation that’s needed to get better drugs and vaccines from the lab to the bedside, governments need to consider new models of innovation that put lives over profits to deliver these needed medical tools quickly and affordably.

A related problem is that those drugs that already exist are not available everywhere they are needed. This problem is not restricted to low-income countries or humanitarian crises. Not one of the three new TB drugs mentioned earlier is registered for use in Canada; nor are other decades-old drugs like rifapentine, a drug so important for public health that Canada imports it in bulk from unapproved foreign sources for what Health Canada explicitly labels a “TB crisis”, yet which no pharmaceutical company seems interested in selling in the Canadian market.

This is a stark reminder that that barriers to effective TB treatment need to be addressed everywhere. While TB is no longer the leading cause of death in Canada, as it was at the time of Confederation in 1867, the disease remains a real public health concern. For instance, in 2021 Saskatchewan saw over 100 cases and two deaths.  It is also a problem that very disproportionately impacts Indigenous communities, particularly in the North, as well as people born outside of Canada. That TB remains a problem in a well-resourced country like Canada is a reminder  of the seriousness of the problem, and the importance of taking seriously the need to devote sufficient resources to addressing it, at home and abroad. This World TB Day, Canada needs to invest in ensuring access to existing tools, and in developing new ones, that can be used to build a world without TB.

Note: This piece also appears on the Doctors Without Borders/Médecins Sans Frontières (MSF) Canada analysis page: https://www.doctorswithoutborders.ca/content/analysis

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