The FDA approves a breakthrough treatment for the world’s deadliest infectious disease — now what?

Treating tuberculosis (TB) is an arduous task, but a recent breakthrough could be a game-changer. Only 34 percent of patients with treatment-resistant TB are cured, including some taking 20 or more pills every day for at least a year and a half.

That’s why the U.S. Food and Drug Administration’s approval of a new drug to tackle treatment-resistant TB has been hailed as a monumental breakthrough. TB is the leading infectious disease killer in the world, taking the lives of 1.6 million people a year. The new drug, Pretomanid, taken in combination with other anti-TB drugs bedaquiline and linezolid, demonstrated an 89 percent success rate in a clinical trial in South Africa; Pretomanid requires only a six-month oral regimen.

The question now becomes: How do we make sure that the people who need this new treatment — and other TB prevention and treatment efforts — have access to them?

From my experience as the former U.S. Global AIDS Coordinator and, currently, as the UN Special Envoy on TB, the answer is for all parties is to work together to increase financing and strengthen coordination targeted where the need is the greatest. 

This shared responsibility model means that impacted countries must step up their game and provide more financial resources to tackle TB. This was underscored by a March report on TB from the Lancet Commission, which I was honored to co-chair. The report found that most high-burden TB countries can substantially increase public domestic financing of TB. By 2023, countries such as Bangladesh, Zambia, China and Indonesia can potentially increase their annual TB expenditures more than five times.

I have long been an advocate of country ownership: rather than relying heavily on donor support, impacted countries can move towards taking care of their own people. This transition to country ownership does not take donors off the hook by any means. Foreign donor support will still be needed, as stated by the Lancet Commission, to target resources directly to address drug-resistant TB, invest in research and development and encourage sustainable domestic funding to control current TB cases. 

To get new treatments like Pretomanid to TB patients around the world, it is also critical that donor nations provide bilateral assistance as well as increased resources for the Global Fund — the world’s largest TB funder and perhaps the best model of shared responsibility. Foundations must also continue to provide their generous support.

According to the Stop TB Partnership’s Global Plan to End TB, an estimated $10.4 billion is needed to alleviate the global burden of TB. With just over $6.9 billion in TB funding available as of 2018, we have a way to go. 

Above all else, as someone who has watched too many people perish from deadly infectious diseases, I do not believe that our fight against TB and other diseases can be won without universal health coverage (UHC) — where everyone receives the health services they need with financial protection. This is particularly true with the rise of non-communicable diseases such as heart disease and diabetes rightfully demanding attention in low-and middle-income countries. 

The recent news about the approval of Pretomanid is indeed exciting. Nonetheless, it will take a shared responsibility from all in the global health community, as well as significant movement on UHC, to ensure treatments get to those who need them most.

Dr. Eric P. Goosby is the UN Secretary-General’s Special Envoy on TB and the MacArthur Foundation Chair in Global Health Sciences, University of California, San Francisco.


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