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“My frustration is that everything is still five, ten, fifteen years down the road. In Lesotho, we need newer drugs and diagnostics now. It seems we can't possibly go fast enough and we're in this perpetual race against time when it comes to TB.” Rachel Cohen, MSF Head of Mission, Lesotho.
Where are the drugs and diagnostics to tackle this global health crisis?
Virtually no research into TB drugs has been carried out since the 1960s. Once the disease was effectively eradicated in wealthy countries, pharmaceutical companies lost interest in developing new products. With no market incentive in developing drugs for people in poorer countries unable to afford their high prices, research activity slowed to a standstill.
Mapping the gaps in research and development
In order to focus attention on the desperate lack of medical tools to tackle TB, MSF produced an analysis of research currently underway into drugs and diagnostics for TB, highlighting the gaps where work needs to be done.
After 40 years of inactivity, new compounds are now under investigation. But there are still far too few candidates that are likely to make it through to the final stage. The advances made in basic scientific knowledge of the bacterium that causes TB are only very slowly being translated into drugs necessary to revolutionise TB treatment and curb the epidemic. A parallel report examining current diagnostics research revealed even fewer promising developments suited to the settings where we work.
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MSF analysis of the TB drug development pipeline 
MSF analysis of the TB diagnostics pipeline
“We in the TB community have not learned all the lessons we could learn from the HIV community. There was a tremendous amount of activism in the HIV community. People made a lot of noise and they didn't ask for funding for research-they demanded it. We have to demand funding. We have to make some noise and get people to pay attention.” Dr. Neil Schluger, Chairman of the Steering Committee, Tuberculosis Trials Consortium (TBTC).
Working in innovative ways to speed up drug development
MSF is supporting the push to accelerate the development of new drugs for patients with drug resistant TB. International experts have proposed carrying out drug trials in drug-resistant patients through an innovative trial design that could deliver new treatments for DR patients more quickly. At present the main strategy for drug development is to generate a completely new regimen. This won't happen within a decade. That's too late for the nearly half a million new patients with drug-resistant TB that emerge each year.
No Time to Wait
At a conference hosted by MSF in New York in 2007, participants underlined the urgency of developing new tools to meet the challenge TB poses to global health and set out a number of demands to ensure that TB research receives the attention and funding it desperately needs.
Summary of demands from NY conference
Around $900 million needs to be invested annually in the development of new tools for TB, but only $206 million was invested in 2005, and the funding gap is expected to widen over time.
IGWG - the way forward ?
TB research has suffered chronic neglect for many years. It's estimated there's an annual shortfall of US$800 million dollars a year. MSF is supporting the negotiations underway at the WHO aimed at changing the present R&D profit-driven paradigm to one which targets research towards diseases that affect those most in need in developing countries. The Intergovernmental Working Group (IGWG) is due to conclude this process in May 2008.
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