Devex CheckUp: The long effort to give the world access to a new TB drug

Access to medicines for all is often used as a catchphrase in the global health space. But it isn’t always the case, and when it happens, it doesn’t come easy.

One drug that has captured the public’s attention in recent years — thanks in part to celebrity novelist John Green’s advocacy — and has been the subject of court rulings is bedaquiline, a novel tuberculosis drug that has fewer side effects than its predecessors and is more effective in treating multidrug-resistant TB.

Bedaquiline received an approval from the U.S. Food and Drug Administration in 2012, a decade after it was discovered by researchers at Janssen, a subsidiary of Johnson & Johnson. But cost and regulatory hurdles prevented those afflicted with TB in many low- and middle-income countries from getting swift access to the drug.

In an in-depth piece, my colleague Andrew Green traces the decade-long history of efforts from different players for broader access to bedaquiline — endeavors that culminated in 2023 when J&J announced it would no longer enforce any secondary patents on the drug in 134 low- and middle-income countries.

Read: Fighting drug-resistant TB was costly. Here's how that's changed

From the archives: 4 questions for John Green, the ‘tuberculosis hater’

One big number

That’s how many people are projected to die because of bacterial antimicrobial resistance between 2025 and 2050, according to the Global Research on Antimicrobial Resistance Project. That’s about three deaths per minute from AMR, with parts of Asia and sub-Saharan Africa most affected.

Adults aged 70 years and older are most vulnerable. Deaths from AMR among this age group increased by more than 80% between 1990 and 2021, and they account for 65.9% of the estimated deaths that will be attributable to AMR in 2050.

The estimates are published ahead of the second U.N. high-level meeting on AMR on Sept. 26 during the U.N. General Assembly, where world leaders are expected to make commitments to mitigate the growing threat, including reducing global deaths associated with bacterial AMR by 10% by 2030.

But …

Tackling AMR requires money. On the African continent, where AMR deaths are already surpassing deaths from malaria, HIV, and TB, a new report by the African Union estimates that $2 billion to $6 billion is needed annually to address the problem.

The investments are needed in a wide range of areas, such as improving sanitary conditions and infection prevention measures in hospitals and building laboratory capacity to detect drug-resistant bacteria.

According to the report, 1 in 3 hospitals in Africa lacks clean running water, and less than 2% of 371 laboratories surveyed in 14 African countries analyzed priority bacterial pathogens for drug resistance.

Read: The African Union crafts a continental position on AMR ahead of UNGA

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Deep pockets

Here’s another global health threat requiring money — financing to help countries adapt to the effects of climate change on health.

Donors committed about $1 billion for climate and health at the 28th U.N. Climate Change Conference in Dubai last December. However, Dr. Naveen Rao, senior vice president for health at the Rockefeller Foundation, says this is nowhere near the $11 billion the U.N. estimated is needed to help countries deal with the health impacts of climate change.

Next week’s UNGA is expected to feature a lot of discussions about the issue. While that means it’s getting a lot of attention now, Rao says for him it all comes down to the money.

“Walking the talk is all about a serious commitment to help countries with their adaptation plans, specifically on health. And I want to see the dollar number. I want to see it increase,” he says.

Read: Climate finance for health — ‘woefully short, woefully slow’ (Pro)

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A ticking time bomb

In August, the Palestinian Health Ministry detected the first confirmed case of polio in a 10-month-old infant in Gaza. Soon after, U.N. agencies started working on a plan to vaccinate children under 10 years old throughout the area.

But it was complicated. The ongoing war means bombings are a constant threat, and that the population is always on the move. The U.N. needed to coordinate details of the plan with Israeli authorities, identify locations to vaccinate children, and make sure parties abide by a humanitarian pause so they can administer the shots safely.

The parties agreed to a partial pause in three zones, over the first 12 days of September. But the cease-fire ended at 2 p.m. daily, meaning health workers had to stop vaccinating by around 1 p.m.

It wasn’t ideal, but Khalaf says they didn’t have any other options. “We either accepted this or the children wouldn’t be vaccinated,” he tells my colleague Sara Jerving.

Read: A race against time — inside Gaza’s polio campaign

Viper no viping

In 2019, the World Health Organization released a strategy for the prevention and control of snakebite, which affects more than 7,000 people every day and leads to as many as 138,000 deaths a year. The strategy’s goals include increasing access to high-quality antivenoms and increasing awareness about snake bites to try and halve deaths and disability from them by 2030.

Five years on and they’re making progress, despite some serious setbacks.

Among the wins they’re counting is the launch of national action plans to tackle snakebites in countries such as India, which has one of the highest rates of it globally. WHO has launched a database identifying snakes, where they are found, and which potential antivenoms are available. The U.N. health agency is also working on a pooled procurement of WHO-recommended antivenoms in eight West African countries, and expects the first products under the scheme to be available in the countries by August 2025.

But there are some challenges. David Williams, WHO’s snakebite expert, tells my colleague Vince Chadwick that data on deaths from snakebite is patchy, making it tough to raise money or get governments to grasp the program’s importance.

“It’s always going to be hard to convince governments to just lash out lots of money to provide health care coverage for these sorts of things if they have no data,” he says.

Read: The plan to give WHO’s snake venom strategy more bite

What we’re reading

Taliban suspends polio vaccination campaigns in Afghanistan. [PBS]

WHO Director-General Tedros Adhanom Ghebreyesus said famine-hit Sudan is not getting the attention it needs because of racism. [BBC]

The United Kingdom has ordered more than 150,000 mpox vaccines after WHO declared a global emergency. [The Guardian]