There is a strange atmosphere this World Tuberculosis (TB) Day as we are currently living through a major global health crisis where each one of us is affected in some way. As the number of cases of COVID-19 rise, an infectious disease affecting the respiratory system for which we currently have no treatment or vaccine, it brings me to reflect on TB.

We must not forget that on this day more than 4,000 people around the world will die of TB, and close to 30,000 will fall ill from this disease that is both preventable and for which we have a cure.[1] Most of those with active TB live in low- and middle-income countries, and many are co-infected with HIV.

Earlier this year I travelled to Ukraine to meet with some of our key partners and discuss the impact of MPP’s work that is ongoing in access to medicines for HIV and hepatitis C. MPP’s mandate covers TB, and I took this opportunity to discuss with the Ministry of Health, along with NGO’s Alliance for Public Health and 100%Life on the current TB situation in Ukraine.

Ukraine has made good progress in the fight against TB. Latest estimates show that there are around 20,000 diagnosed cases of TB a year and a steady decline over the past few years of new cases. Despite achievements, the numbers of multidrug-resistant TB (MRD-TB) cases remain significant, with 30 to 35% of people diagnosed having MDR-TB and a treatment success rate of just 49%. Ukraine is identified by the World Health Organization (WHO) as one of the top 20 countries where there are the highest estimated numbers of incidence of MDR-TB cases.[2] At the end of 2019, WHO published a rapid communication on key changes to the treatment of drug-resistant tuberculosis, the changes include the introduction of all-oral bedaquiline containing regimen for the treatment of MDR rifampicin-resistant TB. Ukraine is hoping that new TB regimens will significantly improve treatment outcome, and as the country transitions from Global Fund funding, access to affordable treatments for TB will be essential.

Our goal at MPP is to ensure that everyone has access to the treatment they need. Already our work in HIV and hepatitis has generated substantial savings to countries, though access to quality, affordable generic versions of essential medicines. Our latest impact statement shows that MPP’s accomplishment for the period 2012 through 2019 generated savings of USD 1.44 billion, with 31.4 million patient-years of treatment supply representing 11.7 billion doses of treatment. In just the last six months of 2019, MPP’s work generated savings of USD 210 million and two billion more doses of treatment were delivered.

In the TB space, MPP signed a licensing agreement with Pfizer in October 2019 to facilitate the clinical development of sutezolid, an investigational medicine for the treatment of TB. Pfizer granted MPP a non-exclusive, worldwide and royalty-free licence allowing potential future MPP sublicensees to access Pfizer’s preclinical, phase I and phase IIa clinical study data and results with the aim to further study, develop and make available this potential important component of new TB regimens. Through MPP’s product prioritisation mechanism that draws on the expertise of our Expert Advisory Group and Scientific Advisory Panel, along with consultations with global health actors, we have identified a number of TB medicines for which we hope to obtain additional licences that will allow for more generic medicines to be available for both adult and children or that may represent important new treatments in the future, following ongoing clinical trials.  We regularly engage with the Global Drug Facility, who as the leading procurer of TB medicines understand countries’ needs.  There is much to do in TB to ensure countries and particularly those affected by MDR-TB have access to quality affordable treatment.

With around 10 million people worldwide falling ill each year with active TB, COVID-19 is a frightening prospect, in particular to those who have recently been diagnosed, or are on TB treatment, or have an underlying health condition. As the world looks towards new treatments for COVID-19, MPP stands ready to support access to treatment through its voluntary licensing mechanism in low- and middle- income countries. Already on MedsPaL the latest patent information is available on remdesivir, favipiravir and lopinavir/ritonavir, three products that may show promise at the end of the ongoing clinical trials, and we will continue to update our patent database as other potential COVID-19 treatment products emerge.  MPP is committed to continuing our work with originators and generic manufacturers, in partnership with the global health community, so that the best treatments are available to those who need them most.

As the world celebrates World TB day 2020 from the confines of our homes, it is a stark reminder for us to stay united in these challenging times and to join forces in what we have to offer in the fight against infectious lung diseases in every form.

It’s time to end TB.

Charles Gore

[1] https://www.who.int/tb/en/  2018 Annual figures: 1.2 million death 10.8 million people fell ill with TB

[2] WHO Global TB report 2019 https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1