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17 Aug 18 06 Sep 18

Speaking out for patients worldwide: How Canada can step up in the fight against TB

Doctors Without Borders/Médecins Sans Frontières (MSF) does not just deliver medical care, but also advocates on behalf of our patients around the world who need access to better, lifesaving standards of treatment. Right now, we are calling on governments around the globe, including Canada's, to #StepUpForTB by addressing one of the world's deadliest and most neglected diseases: tuberculosis

From the Summer 2018 issue of Dispatches, the MSF Canada magazine

By Jason Nickerson

We’re running out of viable options for treating one of the world’s oldest, and most ubiquitous, diseases: tuberculosis. More than 10 million people contracted tuberculosis (TB) in 2016 alone, and more than 1.7 million people died from it the same year, making it one of the deadliest disease pandemics in the world.

What’s more, this epidemic includes 600,000 cases involving drug-resistant forms of TB (DR-TB). In those cases, at least one of the most effective first-line drugs for treating TB no longer works. And for the more than 490,000 cases of multi-drug resistant TB (MDR-TB), two of the most potent drugs, isoniazid and rifampin, remain ineffective.

Doctors Without Borders/Médecins Sans Frontières (MSF) runs TB programs in more than 20 countries around the world, and last year started more than 18,500 patients on first-line TB treatment, and 3,600 patients on MDR-TB treatment.

New treatments urgently needed

But the treatment for TB is long, painful and sometimes ineffective, and gets worse with resistant forms. Drug-sensitive TB (meaning there is no resistance) requires a six month course of treatment, while DR-TB requires a minimum of five different antibiotics, all of which are toxic and include side effects such as permanent deafness, nausea, vomiting and pain. Despite the treatment lasting up to two years and requiring up to 15,000 pills, the success rate is only approximately 50 per cent.

Although millions of people around the world are affected by TB and suffer the poor outcomes of current treatments, there has been little investment in new and effective tools to diagnose, treat or prevent the disease. In fact, investment in research and development (R&D) for TB has actually decreased.

This lack of investment in TB R&D has resulted in only two new compounds registered for the treatment of DR-TB in the last 50 years. What’s worse is that the pipeline is running dry: there are only seven compounds in development, far short of the Stop TB Partnerships Global Plan (2011 -2015), which called for 21 by 2015.

This is a global health problem that is at crisis levels because of indifference and neglect. The crisis of indifference stems from the belief that TB is a disease of the past, instead of a disease that kills millions each year. Canada still recorded over 1,600 cases of TB in 2016, and although the spread of TB in most parts of Canada has been contained for decades, rates of TB among certain populations show a clear inequity. Indigenous populations have disproportionately high rates of TB, particularly among Inuit where the rate of TB in 2016 was more than 300 times higher than in the non-Indigenous, Canadian-born population.

But even in Canada, gaining access to the medicines necessary for treating TB isn’t straightforward. First-line TB treatments are registered in Canada. However, of the 11 treatments for DR-TB in the Canadian Tuberculosis Treatment Standards, only five are registered for sale in Canada. The others can only be accessed through mechanisms intended to be for exceptional access issues or emergency public health crises – which are not fitting descriptors of a disease that has existed for millennia and has been present in Canada for over a century.

Canada can make a difference

But we may be at a global turning point for TB. On September 26 of this year, the United Nations will host the first-ever High Level Meeting on Tuberculosis (UNHLM). This is an opportunity for countries to take meaningful action to close the gap in access to TB diagnosis, treatment and prevention, and to make bold commitments to develop the new medical tools that are needed to do this.

Canada’s government has made clear it seeks to be a global health leader. Last spring, Prime Minister Justin Trudeau wrote an article for medical journal The Lancet in which he highlighted Canada’s “leadership role to end epidemics that disproportionately affect women and girls, including AIDS, tuberculosis and malaria.” Canada can take steps to live up to this proclamation by coming out front-and-centre at the UNHLM and making tangible commitments to end the global TB emergency at home and abroad. 

In March, Canada’s government, alongside the Inuit Tapiriit Kanatami, announced a commitment to eliminate TB across Inuit Nunangat by 2030 and to reduce the incidence of active TB by at least 50 per cent by 2025. These kinds of specific time-bound targets for eliminating TB are what other countries should be implementing, and Canada can show leadership by pushing its allies to make similar commitments. But achieving these targets will be impossible without the medical tools to get us there. We need countries with productive biomedical research and innovation capabilities, like Canada, to step up for TB and commit to developing the medicines, diagnostics and vaccines that we need to end the pandemic quickly.

Canada seems committed to taking action on TB at home and has shown leadership globally by, for example, hosting the 2016 replenishment of the Global Fund. These commitments matter. But they are not a replacement for action. Today, the world needs Canada to act and to lead. That means that the Canadian delegation should have strong leadership – ideally led by Prime Minister Trudeau himself – and should make ambitious commitments that help patients, communities and health systems end TB.

Jason Nickerson is a humanitarian affairs advisor with Doctors Without Borders/Médecins Sans Frontières (MSF) Canada.

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