World TB Day 2023 Blog: Our World TB Day 2022 Blog, But We’ve Added “Still”

The feeling of déjà vu is so strong when crafting a post for World Tuberculosis (TB) Day in 2023 that we are reposting the World TB Day 2022 post in its entirety below.

One bright spot over the past year is that our knowledge of how to treat TB using tools that already exist has continued to improve. New drug regimens offer faster, safer, more effective treatment for patients. MSF was directly involved in the development of a novel regimen for drug-resistant TB through the TB-PRACTECAL trial. At the same time, MSF continues to take action to improve access to medicines, from pushing back on attempts by pharmaceutical companies to obtain new patents on existing drugs like bedaquiline to advocating to ensure tuberculosis drugs are available and affordable to everyone who needs them. New resources, including the 8th edition of MSF’s DR-TB (Drugs) Under the Microscope report, help support these efforts.

On the Canadian side, too, the past year has seen some positive developments. Canada listened to advocates during the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, increasing its contribution by 30%. MSF will continue to advocate to ensure these funds are used effectively. Ironically, however, many of the drugs Canada’s Global Fund contribution will help provide access to around the world remain formally unavailable and unnecessarily complicated to obtain in Canada, a situation that has persisted for years. Hopefully there will be a different story to tell for World TB Day 2024.

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

By Adam Houston, Medical Policy and Advocacy Officer for Doctors Without Borders/Médecins Sans Frontières (MSF) Canada.

©️ MSF

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 still continues to receive but a fraction of the attention directed at COVID-19.

MSF still treats TB patients all over the globe, and is still 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 still 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 still 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 still do not have access to effective HIV treatment and care. TB is also still frequently connected with poverty, lack of access to nutritious food and many of the other serious systemic issues MSF still encounters in humanitarian settings.

MSF nurse checks a DR-TB patient’s heart rate in the Regional TB Dispensary, Zhytomyr, Ukraine. March, 2021.
MSF nurse checks a DR-TB patient’s heart rate in the Regional TB Dispensary, Zhytomyr, Ukraine. March, 2021.

One crucial issue still 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 still among the many countries that are not meeting global targets for contributing to TB research.

GIF. "We're still waiting. For adequate funding to develop new tools to prevent and treat tuberculosis"

©️ MSFTB research, at home and abroad, still urgently requires more attention. The pharmaceutical industry still displays little interest in a disease that affects millions of people each year. If they are still 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 still that those drugs that already exist are not available everywhere they are needed. This problem is still 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 still which no pharmaceutical company seems interested in selling in the Canadian market.

GIF. "We're still waiting. For access to existing tuberculosis tools everywhere they are needed."

©️ MSFThis is a stark reminder that that barriers to effective TB treatment need to be still 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 still 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 a country like Canada is still 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 still needs to invest in ensuring access to existing tools, and in developing new ones, that can be used to build a world without TB.