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World Health Assembly resolution on drug resistant TB: “A good step forward”

Multidrug-resistant tuberculosis is an emerging public health catastrophe. Yet the issue was initially dropped from the agenda of the 2009 World Health Assembly (WHA), the annual gathering of health ministers in Geneva. But developing countries fought successfully to get it reinstated and the final resolution voted through urges countries to achieve universal coverage for diagnosis and treatment of drug resistant TB.

Access Campaign director Dr. Tido von Schoen-Angerer explains why the resolution on TB adopted at the WHA shows that after years of neglect, change could now be on the way.

What is the significance of this resolution on tuberculosis?

It’s a very important step towards dramatically increasing provision of treatment for multidrug-resistant and extensively drug resistant tuberculosis (MDR- and XDR-TB).  Although we’re disappointed that countries have stopped short of committing to specific targets for putting patients on treatment, this resolution is a clear sign that treatment of MDR-TB is an international priority and that neglecting the problem is not an option.

The resolution tells WHO to work with countries to set clear targets and monitor progress, so countries will be under the spotlight to demonstrate progress. Countries also agreed to take steps to ensure strict quality standards of medicines -  essential to prevent resistance developing against the last effective drugs for MDR- and XDR-TB.

This is good news - we’ve been calling on countries to do more to rapidly increase the number of patients that have access to treatment, particularly the high burden countries that are most hit by resistant strains of TB.  The World Health Organization says that there’s half a million new cases of MDR-TB every year, but less than 3% of patients actually have access to treatment according to international guidelines. 

What needs to happen to increase access to MDR-TB treatment?

Scaling up access to MDR-TB treatment is not easy, but it’s possible.  To achieve the global target of 1.6 million patients treated by 2015, we’re going to need better tests and better drugs.

The increasing number of people that have MDR- or XDR-TB was a catastrophe foreseen - because no new drugs have been developed in decades. TB is a disease that hits the poor hardest, and because of that there’s little prospect of commercial rewards if you develop a  new TB drug, for example.  This means medical research into TB has long been neglected and the diagnostics, drugs and vaccines that we have today are completely inadequate – the tests for example, miss many more of the people living with HIV/AIDS and who also have TB than they detect.

There are current efforts to develop new drugs, diagnostics and vaccines and they are important, but they are far from sufficient.

So what does the resolution mean for TB research?

In the resolution, countries again emphasized that alternative financing mechanisms for research and development (R&D) are needed that stimulate more innovation and at the same time ensure affordable access to the product – through mechanisms like a prize fund for TB point-of-care test, for example. 

On the question of alternative financing mechanisms, a number of developing countries have proposed creating an R&D treaty as a sustainable way to address the huge disparities in the way health research and development is prioritised.

Heated discussions took place during the WHA as some of the richer countries are against the idea and did not even want WHO to have a role in exploratory discussions. But in the end it was clear that the needed discussion on a treaty will continue. This is promising, and its something we'll need to continue to work on.

All of these measures are needed to break the cycle of neglect in TB research.

For more info:

Read MSF’s intervention during the UN health talks calling on countries to act.

WHA resolution on MDR-TB and XDR-TB

Download: MSF’s background document on the new faces of tuberculosis.  

Video: MSF patients say why they want a TB test that works for them.

Read more about Access Campaign activities to promote medical innovation

Last updated: May 2009