2016 Report on Tuberculosis Research Funding Trends, 2005–2015: No Time To Lose

OCTOBER 25, 2016

By Mike Frick

Tuberculosis (TB) killed 1.8 million people in 2015, making it the most deadly infectious disease worldwide, but funding for research into better TB prevention, diagnosis, and treatment dropped by US$53.4 million, according to Treatment Action Group’s 2016 Report on Tuberculosis Research Funding Trends, 2005–2015: No Time to Lose. In 2015, the world spent US$620.6 million on TB research and development (R&D), the lowest level of funding since 2008. This marks the second straight year that funding for TB R&D has fallen, raising doubts over whether world leaders will fulfill recent promises to combat antimicrobial resistance (AMR) and eliminate TB by 2035.

“The world spent less on TB R&D last year than it did at the height of the great recession,” said Mark Harrington, executive director of Treatment Action Group (TAG). “Chronic underfunding of research in TB, the leading global cause of antimicrobial resistance deaths, shows that governments must dramatically increase funding for United Nations pledges on antimicrobial resistance to become more than nice words on paper.” The UK government’s Review on Antimicrobial Resistance predicts that drug-resistant TB (DR-TB)—a form of TB that is more difficult to diagnose and treat and that caused 500,000 people to fall ill in 2015—will account for a quarter of the 10 million annual AMR deaths by 2050 unless research into new diagnostics, drugs, and prevention methods is accelerated.

TAG has conducted a global survey of funding for TB R&D each year since 2005, and it has measured actual spending against the targeted funding called for by the Stop TB Partnership’s Global Plan to Stop TB, 2011–2015. The Partnership estimated that US$9.84 billion for TB R&D was needed between 2011 and 2015 to end TB as a public health threat. TAG’s research shows that actual funding for TB research amounted to US$3.29 billion during that time frame, just one-third of the target. The two largest funders—the U.S. National Institutes of Health and the Bill & Melinda Gates Foundation—together gave 57 percent of all money spent on TB research from 2011 to 2015. Over the same period, pharmaceutical industry investments in TB R&D dropped by 40 percent, further intensifying the reliance on public and philanthropic donors.

“Despite a critical shortage of resources, scientists have managed to make significant advances against TB over the last five years,” said Erica Lessem, TB/HIV project director at TAG. “This demonstrates that TB research provides a good return on investment, but investment remains too low to unlock the transformational innovations in prevention, diagnosis, and treatment needed by people with TB and those that care for them.” Notable scientific advances over the past five years include:

• the conditional approval of two new drugs from novel classes (Janssen’s bedaquiline and Otsuka’s delamanid) to treat DR-TB, the first in over four decades;
• the development of a shorter regimen for treating latent TB infection that is safe and efficacious in children and people with HIV;
• the development of several new diagnostic tests, including the rollout of a rapid and robust alternative to smear microscopy (GeneXpert), a simple test that can identify TB in people with HIV with very low CD4⁺ T-cell counts (Determine LAM TB), and several options for diagnosing first- and second-line drug resistance faster than conventional culture (line probe assays); and
• significant advances in fundamental understandings of TB biology.

The next phase of TB R&D may require even more costly and complex endeavors to build on these achievements. “There is no time to lose,” said Lucica Ditiu, executive director of the Stop TB Partnership. “Political leaders must recognize that TB is an urgent threat to global health whose solution will depend on science. Governments must step up to reverse the troubling decline in TB research funding, or we risk losing the battle with TB.”

TAKE ACTION: Turning this declining trend around will require increased political commitment from all countries but especially from leaders of the BRICS countries (Brazil, Russia, India, China, and South Africa), which bear the greatest TB burden. On December 16, the BRICS Ministers of Health will meet in New Delhi, India. TAG will send a petition from the TB community prior to the meeting to urge the ministers to turn their previous statements of resolve into action against TB. The petition encourages the health ministers to work within their governments to triple the amount of funding available for TB research.