never start treatment—risking the escalation of disease/amplification of drug-resistance, enhanced infectivity and transmission of disease to others, and death. Also, compared to the 6-9 month treatment course for drug-susceptible TB, treatment of DR TB requires a daily regimen of less potent, more expensive and more toxic drugs over the course of 2 years or more. Ensuring a reliable and affordable supply of high-quality SLDs is a complex public health intervention that, thus far, has not been organized or implemented in a way that allows all providers and patients access to second-line anti-TB drugs when they are needed. In 2010, the Green Light Committee (GLC)-approved (and thus quality-assured) 42,033 SLD patient treatments,2 reaching only about 6.47 percent of the estimated cases of MDR TB. Although some MDR TB patients not having access to SLDs through a GLC-approved program receive appropriate treatment through a government-run or other quality assurance program, it is estimated that 90 percent of patients with drug-resistant TB are not receiving treatment through a government-run or quality-assured program; thus they are likely receiving treatment from sources of unknown quality (e.g., the local pharmacy), or no treatment at all. The involvement of both the public and private sectors is important to ensure that patients receive effective second-line drugs in a timely and cost-efficient manner.

This public workshop will explore innovative solutions to the problem of how to get the right SLDs for MDR TB to people who critically need them. More specifically, the workshop will examine current problems and potential opportunities for coordinated international efforts to ensure that a reliable and affordable supply of high-quality SLDs is available.

The workshop objectives are to consider:

•   To what extent and in what ways current mechanisms are or are not effectively accomplishing what is needed, including consideration of bottlenecks.

image    What are the advantages and disadvantages of centralization in the management of the global drug supply chain, and potential decentralized approaches to improve operations of the supply chain.

image    What can be learned from case studies and examples from other diseases (e.g., malaria/Affordable Medicines Facility and HIV/AIDS/PEPFAR).

•   The current allocation of responsibilities and roles of the private (including industry and nonprofit public health organizations) and


2 GDF Annual Report, 2010, available at, p. 10 (accessed October 18, 2012).

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement