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Intervention by Médecins Sans Frontières on tuberculosis at World Health Assembly 2009

Intervention as a part of the tuberculosis session during 62nd World Health Assembly, May 2009
Thank you Chair,
My name is Dr. Tido von Schoen-Angerer and I am speaking on behalf of Médecins Sans Frontières. 
Member States have taken an important positive step by ensuring that multi- and extensively drug-resistant tuberculosis (MDR and XDR-TB) is back on the agenda of this year’s World Health Assembly (WHA).
In 2007, MSF provided MDR-TB treatment to 574 patients across 12 countries and we are striving to increase the numbers of people we treat. 
The lack of access to treatment for MDR-TB is striking: The World Health Organization (WHO) has reported that fewer than 3 percent of the estimated total number of M/XDR-TB cases receive treatment according to international guidelines and with quality-assured medicines.  This falls dramatically short of progress needed to reach the agreed global target of enrolling 1.6 million M/XDR-TB patients on treatment by 2015.
The meeting of high-burden countries in Beijing and its call for action launched much-needed momentum.
Country plans, however, are not expected until later this year. If we are to meet this objective, WHO and high-burden countries need to begin acting now. It has been estimated that at country level a ten percent annual increase in patient enrolment will be needed in order to reach global targets. Country targets still need to be identified, as do country indicators which are needed to monitor progress. WHO needs to work with countries to develop a standard set of indicators.
Particular attention is needed to the needs of persons living with HIV/AIDS and other vulnerable groups, including prisoners and migrants who are at greater risk for acquiring and dying of MDR-TB. In providing care, the rights of vulnerable communities need to be protected to prevent them being turned away due to stigma and discrimination.
Appropriate, patient-centred and community-based models should be adopted. Affected communities and NGOs have a key role to play in not only rolling out treatment but also in monitoring progress of the MDR-TB treatment scale-up. 
Drug quality is a key area that needs to be addressed. The Beijing Call For Action brought important agreement on the critical need to secure sufficient supply of first and second-line medicines for TB treatment, meeting WHO prequalification or strict regulatory authority standards. Without such standards there will be greater risk of resistance developing to the few drug options that are available today.
In addition to this focus on scaling up, there needs to be recognition that global targets cannot be reached without simultaneously working on the developing of better tools. MSF teams struggle daily because our abilities to diagnose, treat and prevent the disease are severely hampered by the limitations of current tests, drugs and vaccines.
Yet here too the shortfall is considerable. The Treatment Action Group puts the annual needs for TB research at US$2 billion, yet barely US$480 million is currently being spent. Current efforts by product development partnerships, while important and laudable, are insufficient to ensure we will get the new tools we so desperately need. In addition, MDR-TB clinical trials are needed to optimise treatment, but no funding is available.
We look to Member States and to WHO to ensure that the work of the Expert Working Group on R&D Financing further advances the use of alternative financing mechanisms – such as prize funds and the exploratory discussions for an essential health and biomedical R&D treaty.  We need financing mechanisms that are able to deliver the tools we need and at prices that are affordable, by delinking the cost of R&D from the price of the products.
Thank you. 
Page updated: 6 May 2009
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