Can the BRICS bank rally global outcasts around TB treatment?

Some of global development’s emerging players could fill a void in aid to the world’s most isolated countries — and their citizens who desperately crave basic services.

For instance, Russia and North Korea’s foreign policy decisions have alienated them from many of the world’s largest aid donors. But new actors are emerging, and some experts speculate that the recently launched BRICS development bank — officially called “New Development Bank” — could take on some of the health and development challenges facing those countries like tuberculosis.

While the BRICS comprise three of the five most TB-affected countries — India, China and Russia — other countries who share the bank’s status outside of the conventional aid inner circle are sending distress signals. As common interests emerge, TB seems premiere among them.

First order of business

The BRICS bank, officially created at the sixth BRICS summit in July, was founded by five emerging economies — Brazil, Russia, India, China and South Africa — as an alternative to the Western-led World Bank and to focus on financing areas of mutual interest.

Tuberculosis could be one of those areas, according to Gail Cassell, senior scientist for global health equity at Harvard Medical School, formerly the Institute of Medicine, who called the Delhi Communique issued last year by BRICS health ministers “a watershed for TB control.”

Cassell presented the recent history of TB efforts to health professionals at the Center for Global Development Tuesday.

“What they acknowledged was that [multidrug-resistant] TB is a major problem,” she told Devex in a later interview. “And they said that they are going to work together to solve it. It’s pretty huge to admit it publicly, but also for them to establish a framework for collaboration.”

The health ministers outlined a cross-sector plan for addressing the disease that includes improving infrastructure, developing a diagnostics platform and collaboration on drug trials.

“That the [BRICS] bank was established only months after that suggests that they will definitely have a hand in what happens next,” Cassell said, seeming to suggest that early investments of the institution’s $50 billion capital might contribute to anti-TB projects in the bank’s hardest-hit shareholders.

The hidden epidemics

For the last few years, Russia has battled TB largely on its own. The U.S. Agency for International Development suspended operations there in 2012, even if the agency had previously classified the country as “priority” for tuberculosis treatment and prevention.

While screenings and data have been spotty, particularly since USAID’s withdrawal, the World Health Organization estimated in 2012 that approximately 320 cases of TB emerge each day in Russia, with 64 deaths associated with the disease. Russia is second only to India in prevalence of MDR-TB.

“The numbers in Russia are vastly understated,” Cassell said. “Testing is mostly based on sample groups, which can be inaccurate, and doesn’t take into account problem areas with poor conditions.”

She noted that the disease is airborne, spreading easily in crowded spaces, and especially problematic among refugee and prison populations. The expert added that much of Russia’s outreach has related to pediatric tuberculosis, which raises other concerns given the country’s declining population.

The battle against TB in North Korea — a beneficiary of loans and aid from China, the largest BRICS shareholder — is shrouded in even greater secrecy. Estimates suggest around 345 out of every 100,000 citizens in the pariah state are infected with tuberculosis, but Eugene Bell, one of only a handful of U.S. NGOs working with MDR-TB patients in the country, claims that figure is vastly understated.

Given North Korea’s hesitation to cooperate with the United States, the fact that the country has reached out on tuberculosis hints at the scale of the epidemic, demonstrated by a delegation of North Korean Ministry of Health officials in 2010 to Stanford University, where they sought information about new drugs, noted Anne Claiborne, a senior program officer at the Institute of Medicine. The urgency is also clear in an international communique issued by the North Korean ministry which stated that MDR-TB “is the number one, two and three biggest health emergency” in the country.

A new addition

As multidrug-resistant tuberculosis evolves, the science behind a cure must evolve faster.

Unfortunately, the drug pipeline for MDR-TB contains only a few contenders, without a single drug in phase 1, the earliest phase of testing. Cassell told health professionals the need for new drugs will likely overwhelm the already underfunded research community.

“In order to treat the patients, you don’t need just one new drug, you need three or four in a cocktail,” she said, noting that the regulation alone will be a daunting task, as FDA approval generally takes at least ten months, on top of the ten-year average for the creation of the vaccine.

In the meantime, a new opportunity for collaboration waits on the horizon in another unlikely locale: Iran.

Iranian officials there are organizing a TB conference in March 2015, Cassell told Devex, and Tehran is offering to fly in health experts willing to offer their knowledge about MDR-TB. According to WHO data, Iran has seen an increase in tuberculosis since 2010, around 21 per 100,000, accompanied by a startling decrease in the number of patients undergoing treatment.

While TB’s effect in many of these countries is still somewhat nebulous due to poor screening, lagging medical technology or a simple lack of transparency, it’s clear that the urgent need to control the illness could rush their entrance into the global limelight.

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