Fighting Drug Resistant TB Through Increased Access to Quality-assured Medicines

In response to: Feeding a Disease With Fake Drugs, NY Times Op-Ed by Roger Bate, Published February 5, 2013

By Andre Zagorski, SIAPS Principal Technical Advisor and Emily Delmotte, SIAPS Technical Associate

Roger Bate is right to point out that while private health care providers may be more accessible than National Tuberculosis Programs, the quality of anti-tuberculosis medicines available can be questionable. However, Mr. Bate fails to mention that any long-term solution to eliminating substandard medicines also requires the involvement of the private sector.

In Africa, the private sector provides roughly half of all health services and can be a valuable entry into TB care. Investment in the private health sector has previously demonstrated the potential for impressive returns, such as a public-private partnership (PPP) spearheaded by the Kenya Association for the Prevention of Tuberculosis and Lung Diseases (KAPTLD) which increased the number of DOTS facilities in the private sector four-fold, while reducing the cost of quality-assured medicines by 90 percent over an 8 year period.

Donors such as the United States Agency for International Development (USAID) are investing in these partnerships to tackle the rising risk of multi-drug resistant (MDR)-TB. For example, the USAID-funded SIAPS Program is collaborating with private sector pharmacies and the Ministry of Health in Tanzania to decrease diagnosis time and increase access to affordable, quality-assured medicines.

By bringing together diverse stakeholders, collaborations between the public and private sectors have the potential to generate solutions that might not otherwise be possible. In addition to investments in PPPs, USAID is also supporting the Global Drug Facility (GDF), an initiative of the Stop TB Partnership that provides access to quality-assured first- and second-line TB medicines to TB programs and NGOs. As the largest supplier of anti-TB products on the public market, the GDF has supplied over 22 million first-line treatments and over 92,000 second-line treatments for drug resistant TB, all of which were either prequalified by the WHO’s Prequalification Program or approved by a stringent national drug regulatory authority. The GDF has a capacity of rapidly doubling the supply of quality-assured medicines in response for growing demand, potentially also from developed countries.

While strengthening supply chains and improving regulatory oversight are necessary, they are not sufficient. Enhancing TB prevention and care also requires partnerships that stretch across the public and private sectors, addressing the challenges of drug quality through a variety of approaches. Attempts to control TB will succeed only when all patients have access to effective treatment, regardless of where they seek care.