A few recent reports track the progress being made by the Stop TB Partnership and TB research funding trends from 2005-2008. As global TB efforts increase in the areas of research, drug, vaccine and diagnostics development, greater emphasis has been placed upon funding. Particularly in light of the recent economic downturn, it is no surprise that funding for TB R&D was a major topic of discussion at the recent IUATLD conference in December 2009. How much money is currently spent on TB basic research? Where does the money currently funding TB research come from? Can more funding outlets be identified?
In April 2008 McKinsey & Company completed an external evaluation of the Stop TB Partnership from inception to 2008 which was commissioned by the Stop TB Coordinating Board. This evaluation was conducted independently of the Stop TB Secretariat and the final document is a product of the staff of the Independent Evaluation Group (IEG) of the World Bank Group. Examples of the general findings:
“The 2008 evaluation concluded that the Partnership had contributed significantly to the global effort to stop TB during 2001–2006, and that it had greatly added value to what would have been achieved in terms of tuberculosis control and research in its absence.”
“The major conclusion of the 2008 independent evaluation was that the Partnership has had a significant impact on TB control and research and should set “high aspirations” for future achievements.”
While the review of the Stop TB Partnership to date is encouraging, the report does not shed significant light on the costs associated with TB R&D, but another report does.
Treatment Action Group (TAG) recently published a report on tuberculosis funding trends. Established in the early 1990s, TAG is an advocacy group focused on increasing HIV/AIDS research and drug development. Their efforts have proven successful as basic research funding and the development and approval of major drugs to control the virus have resulted in the sustaining of many lives. Recognizing the strong association between TB and HIV/AIDS, TAG has recently begun advocating on behalf of TB R&D. TB is the leading cause of death among HIV infected individuals in the developing world. Many of the drugs necessary to treat HIV patients negatively interact with current TB drugs.
Since 2005, TAG has been compiling funding data related to TB R&D. Their goal and strategy is similar to their approach to increasing HIV/AIDS research funding.
“• There is need for increased basic science research as there are critical deficiencies in the understanding of pathogenesis of TB.
• Funding for TB R&D is grossly inadequate relative to its impact in terms of disease and death it causes.
• The lack of research capacity in areas of the world where the disease is common hinders rapid progress.
• Linked to the need for increased basic science research in particular is the lack of useful biomarkers that can be used to diagnose TB, provide a prognosis, and monitor the impact of vaccination or treatment.”
The 2009 Report on Tuberculosis Research Funding Trends summarizes and presents the breakdown of funding amounts from public, private, and governmental organizations from 2005–2008. An evident and unfortunate trend is the lack of substantial increases in funding despite recommendations for a $2 billion increase from TAG and the Stop TB Partnership to reach the Stop TB Partnership Global Plan. With the lack of funding available, it is scary to think that the advances made these last few years in TB R&D will stagnate and the global epidemic of TB will not be controlled.
Additional articles regarding costs for TB R&D to consider:
- Estimated costs for trial capacity sites are $1-2 million per year per site as reported by Schluger et al in a recent PLoS Medicine article.
- At present, are there enough clinical sites around the world to adequately assess new drug combination and regimen trials in addition to new drug trials of current drugs in the pipeline? According to recent research by van Niekerk and Ginsberg, it doesn’t appear we can.
What are your thoughts? Do you believe TB funding is adequate? What other mechanisms or approaches should be utilized that aren’t currently being tapped? Please share below.