Support South Africa at UN – we need better & affordable TB medicines

On 26 September 2018, UN member states will come together in New York to ratify this political declaration, yet current drafts of the declaration are woefully inadequate and undermine efforts to ensure people living with TB have access to better and more affordable TB medicines, vaccines and diagnostics. While current drafts contain some good rhetoric, hardly any concrete commitments are made. Such a lack of concrete commitments will render the declaration and the process around it toothless.

While the South African government is leading the way in attempting to redraft and improve the declaration, pressure is mounting against them, particularly from wealthy countries. For this UN process to have any meaning for the people in South African townships, our hard-won rights to access medicines must be enshrined in the main text of this declaration. These rights are not just a legacy from the last two decades of people with HIV fighting for their lives as part of a larger access to medicines movement, but also a lifeline for people who will need affordable medicines, vaccines and diagnostics tomorrow. What use are new tuberculosis medicines if high prices mean people cannot access them? Our lives must be placed ahead of the greed of big pharma, especially given that most big pharma companies have abandoned TB research altogether.

There are a number of legal safeguards allowed under international law that protect the right to access healthcare and medicines. However, these rights are missing from the current drafts of the declaration. With new medicines for drug resistant TB (DR-TB) becoming available for the first time in over 50 years, using these safeguards will be vital for the future of treatment in South Africa, and across the world. It will be imperative to address patent barriers to lower prices and scale up treatment access, as was the case with HIV treatment in the early 2000s.

Currently medicines are often priced out of reach of those who need them. Bedaquiline for example, is a safer and far less painful alternative to the current injectable medicines that cause hearing loss in nearly half of those who take them. Importantly it also saves many more lives. In South Africa, bedaquiline is priced at USD 400 per course, and in most other countries it costs much more, as much as USD 30,000 in certain places. Yet, researchers estimate a six-month course can be profitably produced for less than USD 100.

Excessive medicine pricing is nothing new to South Africa – a country that faces one of the highest global burdens of DR-TB, with over 19,000 cases diagnosed in 2016. For several years, many people with DR-TB were unable to benefit from the drug linezolid. While it was under patent it was priced at over ZAR 700 (USD 47) per tablet, while generics in India were available at a fraction of the cost at ZAR 25 (USD 2). People who say medicine pricing is not an issue in TB are spitting in the faces of people who needed linezolid and could not access it, and turning their backs on people who cannot access the newer drug bedaquiline.

Using these public health safeguards is nothing new or controversial. UN member states have repeatedly reaffirmed these rights and committed to protecting and using these so called “TRIPS flexibilities” in the Political Declarations emerging from the UN High Level Meetings on HIV in 2006, 2011 and 2016, the Political Declaration signed at the UN High Level Meeting on Non-Communicable Diseases in 2011, the UN General Assembly Resolution on Global Health and Foreign Policy in 2014, and in the Sustainable Development Goals (SDG3b) signed in 2015. The UN High Level Panel on Access to Medicines in 2016 recommended that all WTO members "should commit themselves, at the highest political levels, to respect the letter and spirit of the Doha Declaration," and noted that when governments make "full use of the flexibilities in the TRIPS Agreement, they can protect and advance public health objectives."

In addition to excessive pricing, TB is also typical of a wider crisis of underinvestment by both pharmaceutical companies and governments in diseases mainly impacting poor people. As it stands the global patent regime skews the incentive to research and develop new medicines and medical tools to where the most money can be made. Current drafts of the declaration continue to include problematic wording around this that wrongly suggests patents incentivise R&D – a myth repeatedly peddled by the pharmaceutical industry, and repeatedly proven to be wrong, particularly in relation to TB.