Even expensive drugs can be cost-effective if they keep the MDR/ XDR disease from spreading. Moreover, up-front payments and guarantees could bring prices down.

•   Drugs that are prequalified by WHO or stringent regional regulatory authorities should not have to go through an extended period of regulatory review within individual countries. Regional regulatory agreements can avoid the need for repeated validations by agencies in each country.

•   Adequate funding needs to be applied for training in how to run supply chains, assess and assure quality, and comply with regulations; such training would be useful not only for TB drugs but for other drugs as well.

•   Improved organization and leadership are needed to strengthen the supply of drugs for DR TB. Public–private partnerships could be a way to make expertise in the private sector available to the public sector.

Bloom also observed that successful community-based care of MDR TB patients, such as that implemented in South Africa and elsewhere, is very promising and could be generalized to many other countries.

INCREASING THE VISIBILITY OF DRUG-RESISTANT TB

Panelists also addressed the need for improved global awareness and visibility of the problem of DR TB. Millennium Development Goal 6 calls for combating HIV/AIDS, malaria, and “other diseases.” As Bloom said of TB, “When a disease which is this fatal and this threatening to the world is termed an ‘other’ disease … we have done a poor job of getting the message through.”

Information about DR TB needs to be simplified so that political leaders and members of the public can understand and act on it, said Bloom. As an example, he proposed a “marketing” strategy, proclaiming, “With the appropriate funds, leadership, and organization, we can save X number of lives every year and prevent Y number of lives from being infected with drug-resistant TB.”

Gao made a similar point in his remarks, noting that better treatment will require greater societal involvement, which in turn will require that MDR TB be acknowledged as a serious disease. TB and MDR TB are as much a social as a medical problem. “Without society paying attention to MDR TB, we cannot solve this problem,” he said. In that respect, countries could learn from the response to the HIV epidemic, whereby recognition of the magnitude of the problem led to a greater response than has been the case with DR TB.



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