UN commitments to scale up TB testing and treatment need immediate action

22 September 2023 – Médecins Sans Frontières (MSF) welcomed the second-ever United Nations (UN) Political Declaration on tuberculosis (TB) in which world leaders committed to ramp up TB testing, treatment and prevention, and to close the deadly gaps in all these areas for adults and children. 

To translate these commitments into action and also accelerate access to TB care for children, MSF urged all countries to urgently update their national TB guidelines with the latest recommendations by the World Health Organization (WHO) and to ensure that WHO-recommended tools to diagnose, treat and prevent TB are available to all. There is no room for governments to delay, especially because of the insufficient progress since the last UN TB Declaration five years ago: in 2021 alone, TB still killed 1.6 million people; the WHO reported that 4.2 million people with TB people went undiagnosed (40% of all people with TB); and cases of TB and drug-resistant TB (DR-TB) increased for the first time in many years.  

One prerequisite for countries to be able to efficiently and equitably scale up access to TB medical tools is for needed tests and treatments to be affordable and available. 

This week, US corporation Cepheid, and parent corporation Danaher, made an encouraging decision to reduce the price of the GeneXpert MTB/RIF Ultra test in high-TB-burden countries by 20% (from US$9.98 to $7.97). However, the price of the Xpert MTB/XDR test that is used to diagnose the most severe form of TB will remain exorbitant at $14.90. 

MSF therefore called on Cepheid and Danaher to further reduce the price of all GeneXpert tests, and again, urged Johnson & Johnson (J&J) to not enforce ‘secondary patents’ for the TB drug bedaquiline in any country with a high burden of TB, and withdraw and abandon all pending secondary patent applications.  

“It’s encouraging that Cepheid and its parent company Danaher woke up to this injustice and reduced the price of the GeneXpert MTB/RIF Ultra test by 20%, and we hope now to see similarly meaningful price reductions for all other tests. It’s also imperative that J&J urgently rethink their aggressive patent strategy to ensure that every country can access generic bedaquiline,” said Stijn Deborggraeve, diagnostics advisor for MSF Access Campaign. 

Governments also agreed to take the necessary steps to close the deadly gaps in diagnosing and treating TB in children. 

Diagnosing children with TB is challenging, in part because existing tests are mostly sputum-based and so are not well adapted for use in younger children, for whom producing sputum is difficult. The consequence is that an estimated more than 60% of all children with TB worldwide are never diagnosed, and among children who die because of TB, 96% never received treatment. 

In 2022, the WHO updated its guidelines on paediatric TB to make it easier for medical staff to diagnose and start treatment in children with the available tools, but these guidelines are not yet widely used. Additionally, although child-friendly formulations are available for every TB drug recommended by the WHO, including those used to treat DR-TB like bedaquiline, many high-TB-burden countries have not yet made these adapted drug formulations available to children with TB, nor implemented new treatment recommendations.

“Today’s [22 September] declaration must not remain just words on paper: we encourage countries to take every action possible to save the lives of people with TB, including by immediately updating national TB guidelines and implementing WHO recommendations for improved testing and treatment, and in particular finally prioritising testing and treating children with TB,” said Dr Maria Guevara, MSF International Medical Secretary. 

“Much more needs to be invested in research & development, especially for better TB tests for children. With still 1.2 million children and young adolescents developing TB every year, it is abundantly clear that the world has made insufficient progress since the last UN High-Level Meeting on TB in 2018. Now is the time for renewed political leadership and increased financial commitments to close the devastating gaps in TB care for children.”