To those for whom tuberculosis is largely consigned to the early 19th century, a WHO estimate that one-third of the world's population is infected with Mycobacterium tuberculosis, will come as shocking news.
At present, first-line regimens are complex (requiring a four-drug combination), long (lasting 6-9 months), complicated, and costly in time and resources, for patients and providers. The consequence for many patients is poor adherence to treatment. Add to this burden the emergence of multidrug-resistant and extensively drug-resistant tuberculosis strains, and a global health catastrophe is virtually assured.
New drugs are desperately needed to save millions of lives needlessly lost to this disease. The not-for-profit Global Alliance for TB Drug Development (TB Alliance) was set up in response to this emergency. With 18 new drug candidates in the pipeline, two of them in clinical trials, the TB Alliance analysed the current global tuberculosis drug market in last week, Pathway to patients: charting the dynamics of the global tuberculosis drug market. This study sets out the various options and uses country-specific data to show how tuberculosis drugs get to patients in ten high-burden and high-income countries.
The report shows that before these drugs are developed, manufacturers and policymakers need to understand what the global market for tuberculosis drugs is, and the processes of supply, delivery, and distribution. Without this information, even the most effective drugs will fail.
The TB Alliance's report estimates the global market at 315 million and 54 million for first-line and second-line drugs, respectively. It documents the market's extensive variability and fragmentation and notes that new drugs may require different methods to get them to the people who need them. Planning, policymaking, and public education will also be critical to success. The report recommends a "global infomediary" to shuttle data-driven information between suppliers and national tuberculosis-control programmes. This is an idea that ought to be tried.