IN A bid to stamp out drug-resistant tuberculosis before it sweeps the globe,
the World Health Organization has secured cheap access to the only effective
drugs, 91av has learned.
After months of detailed talks, manufacturers have agreed to slash their
prices by between 60 and 90 per cent when supplying poor countries. The deal
comes just months after the industry’s climbdown over HIV drugs and patents in
South Africa.
Only 1.5 per cent of TB cases worldwide are multidrug-resistant. But
resistant TB is spreading rapidly in hot spots such as Russia. Resistance can
evolve when patients stop taking drugs before the end of the course—a
common occurrence in the squalid jails of the former Soviet Union.
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The pills needed to treat regular TB cost just $10 for an entire
course. But the drugs needed to treat a resistant strain cost as much as
$15,000 per patient—far more than poor nations can afford.
Pharmaceuticals giant Eli Lilly makes two of the five drugs—capreomycin
and cycloserine. While vials of capreomycin normally cost up to $29 each,
the company is selling them to the WHO for as little as $1 each. Eli
Lilly will decide whether to make the pilot scheme permanent after the first
1000 patients have been treated. “We’ll have to see how it moves forward,” says
a company spokesman.
A third TB drug, para-amino salicylic acid, is also to be sold to
poor countries at a discount price by Jacobus Pharmaceutical, a family-based
firm in New Jersey. “It’s a big disease, and not everyone cares like we do about
doing the right thing,” says Laura Jacobus, one of the company’s founders.
Ofloxacin and ciprofloxacin, the two other drugs, will also be supplied
cheaply, says Marcos Espinal, the scheme’s architect at the WHO. The companies
that will make them have not yet been named.
The scheme will only be successful if patients and doctors use the drugs
properly. If they don’t, even worse resistance could develop. “We’re taking a
huge financial loss doing this,” says Jacobus. “We must be really careful it’s
not mismanaged.”
This won’t be easy. Some of the drugs have to be injected daily for two
years. Patients will have to be monitored by nurses in hospitals to ensure they
comply. The companies say they’ll pull out if the WHO fails to follow this
strict regime.
So far, says Espinal, the offer has been taken up in Peru, the Philippines
and in Tomsk and Oriel, two badly hit regions of Russia. Further programmes have
been approved in Latvia and Estonia, where resistant TB is also widespread.
For more on TB, see the special report on p 28 of this issue