ANALYSIS

Unavailability of Tuberculosis drugs expands the epidemic

Using TB drugs in politics is dangerous and unethical. Delay in drugs causes death and disability, further spreading of illness and development of drug-resistant TB. Donors should not take patients as hostages.

According to the WHO, tuberculosis (TB) is the second leading infectious killer, just after HIV/AIDS. In 2010, 8.8 million people had the disease and 1.4 million of them died because of it. This is equivalent to the entire Austrian population being affected by the disease, and everybody living in the cities of Copenhagen and Aarhus being killed by it. TB patients are usually treated in local health centers and the medicine, an inexpensive four-drug therapy for six months is provided free by donors. Yet there are often ruptures in the supply chain of drugs. In a typical high burden country such as Guinea-Bissau – one of the five poorest countries in the world with a high TB prevalence – the TB drugs have not been available three times the past three years.

Donor cuts drugs delivery due to instable political situation

Why is this if the drugs are supposedly provided for free by donors? The national tuberculosis program in Guinea-Bissau states that there has been an error in the recording of inventory stock since last order list was sent to the “Global Fund” / “Global Drug Facility”. “Global Fund” is an international financing mechanism to help combat the three major killers (HIV, Tuberculosis and Malaria) by directing funds to the areas of the world where they are most needed. “Global Fund” works as a partnership between governments, civil society, the private sector (including businesses and foundations) and affected communities.

“Global Fund” has without further explanation not been willing to support further procurement of medicines through “Global Drug Facility”, maybe because of recent corruption scandals among some recipients of aid. UNICEF stepped in on a temporary basis and authorized medicine for two months consumption. But then, as a further complicating factor Guinea-Bissau was shaken by a military coup (the sixth in the country’s short history as an independent nation) in April 2012. In August 2012, the last UNICEF funded medicine ran out. So right now there is a large group of patients exposed to unstable treatment through the past six months and no prospect of getting medicine in the near future.

“Global Fund” has indicated that because of the current unstable political situation in Bissau they are monitoring the situation and awaits drug delivery from the Global Drug Facility. All while this is going on, the patients are waiting for medicine, spreading their illness to family, friends and colleagues and are because of the unstable treatment likely to develop drug-resistant TB, which is much harder and more expensive to treat than the simple curable pulmonary tuberculosis- TB is supposed to be treated, but currently this is not the case in Guinea-Bissau and many other places with instability and vulnerable health care structures.

 

Withholding drugs for political reasons is dangerous

There is already a major problem in undiagnosed and hence untreated TB in many high burden countries- The current ‘Daily Observed Treatment Supervised’ strategy will only contain the epidemic but not eradicate TB. If treatment is not even available after diagnosis, the TB epidemic is likely to expand further and cause death and disability among otherwise often young breadwinners in the poorest areas of the world.

If donor agencies take over a vital health care delivery facility as TB drugs, it is urgent that full responsibility towards ensuring rapid and stabile delivery is taken, even if it means controlling central stocks. The TB drugs are inexpensive and have no other marked value as they are not used for other purposes, so there is no major room for corruption in this area. Withholding these vital drugs in order to push political changes forward is a dangerous and unethical strategy which will not target the involved regimes but only those suffering from TB.

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