GLOBAL TB REPORT: MSF warns of deadly TB testing gap following release of WHO Global TB Report 2021
Geneva, 14 October 2021 – The World Health Organization (WHO) released today the 2021 edition of its Global Tuberculosis (TB) Report, featuring data on TB trends and responses in 197 countries and areas.
For the first time in more than 10 years, the number of deaths due to TB has increased, from 1.4 million deaths in 2019 to 1.5 million deaths in 2020, largely due to the devastating impact of the COVID-19 pandemic on TB care, including testing services. Timely and accurate diagnosis of TB, followed by provision of the most effective treatment, prevents death, limits illness in people who develop TB and reduces further transmission of TB. According to WHO, the number of people newly diagnosed with TB and reported to national governments dropped from 7.1 million in 2019 to only 5.8 million in 2020. This alarming reduction in TB case detection and reporting reflects both supply and demand-side disruptions to TB testing services.
While additional suppliers are entering the market, many TB testing services in countries are still dependent on the GeneXpert TB tests supplied by Cepheid. This US based diagnostics corporation has received over US$250 million in public investments in the last decade to develop and roll out the GeneXpert technology but has fallen short in providing returns to the public and is overcharging low- and middle-income countries for the tests. Despite multiple alarms from civil society around the world, Cepheid refuses to provide transparency on the cost of production and profit margins of tests for TB and COVID-19, amongst other diseases. In addition to overcharging low- and middle-income countries, Cepheid recently decided to cancel the commercialization of its newest GeneXpert technology, a battery-powered, robust and portable GeneXpert system called Omni, that was designed to overcome the shortcomings of the existing GeneXpert system for community-based testing. Doctors Without Borders (MSF) calls on Cepheid, as well as all suppliers of TB tests, to support closing the deadly TB testing gap by ensuring that TB tests are affordable and adapted to the needs in countries.
Stijn Deborggraeve, Diagnostics Advisor, MSF Access Campaign:
“We cannot accept that year after year, up to 1.5 million people die from the curable disease TB because they do not have access to the diagnostics and drugs that can save their lives. With the alarming increase in TB deaths in 2020 due to the COVID-19 pandemic, much more needs to be done to close the deadly testing gap and ensure that many more people with TB are diagnosed and treated. Yet access to diagnostic tests is still limited in many high TB burden countries because they depend on GeneXpert tests supplied by Cepheid, which remain too expensive.”
“Cepheid is an example of a pharmaceutical company prioritizing its shareholders’ profit over people’s lives. Cepheid received over $250 million in public investments to develop the GeneXpert tests, but still prices this lifesaving test out of reach for many high TB burden countries.
“Cepheid’s recent decision to halt the launch of the GeneXpert Omni technology without any explanation or effort to mitigate the impact of the decision on the TB testing gap is outrageous. Cepheid received more than $86.5 million in public funding from the US government to develop the Omni technology to support community-based testing. Cepheid must be held accountable for the public investments made and for its commitments to people with TB. We need all technologies to fight TB and reduce the number of TB deaths urgently.
“MSF is providing TB testing and treatment in 38 countries, and we do not accept that people with TB are unable to access the diagnostic tests they need because companies like Cepheid prioritize profit over saving lives.”
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Simphiwe Zwide - MSF Treatment For TB in South Africa.
Simphiwe holds his medication, he takes up to 26 pills a day to treat XDR-TB. Here he holds his morning selection, which includes delamanid, one of the newest DR-TB drugs, which Simphiwe is taking for the first time today.
Simphiwe Zwide, 43 years, lives in a one-bedroom house with his wife, Nomonde Tyala, and children in Kuyasa, Khayelitsha. Simphiwe was first diagnosed with MDR-TB in 2011. He completed six months of treatment, but when he learned that he had pre-XDR-TB and would need even more treatment, he lost heart and returned to work.
In June 2016, he presented back to his Khayelistha clinic as he had fallen ill again. This time test results showed he had XDR-TB. He took his first delamanid tablets on 12 October, as part of a strengthened regimen for XDR-TB.
Simphiwe’s current regimen: Delamanid, bedaquiline, linezolid, levofloxacin, terizidone, clofazimine, ethionamide
Simphiwe Zwide:
“In 2011, my wife had TB and they admitted her into Jooste District Hospital. I visited her for over a week. When she came out of hospital, I fell sick.
I couldn’t eat, my body was painful, my throat was sore – I thought I had a virus. My wife tried to cook – sour milk and maize meal. I couldn’t swallow. I had to drink many cups of water. I was sweating – I couldn’t walk even couple of metres.
My wife was very supportive of me. She would leave me taxi money and go and stand in the hospital queue for me from 5am.
I started to feel my health returning and I felt like I could work again. I’m the breadwinner, and we were all suffering. I was the only one who could work for my family. I was taking clofazamine injections which meant that I had to attend the clinic every day and this was preventing me from finding a job.
I was between Johannesburg and Cape Town looking for work between 2012 to the end of 2016. Then in January 2016, I started to get sick again. I couldn’t work like I’m used to. I came back to Khayelitsha, now I’m here at Kuyasa clinic getting treated for XDR-TB. I’m joining a support group soon.
I’m a jack of all trades - I learned to be a cleaner, I was piping donuts down at Monte Vista. I do construction, I bake cakes. My big brother taught me how to bake and my cousin is a confectioner.
I’ve been on treatment (including linezolid and bedaquiline ) for two months now. Sometimes I take 26 pills a day.
When I take them, I have to sleep the whole day. But I’m feeling much better, I can’t say I’m 100% but this is only my third month. I know who I am, I’m strong and I want my health back.” Photographer: Sydelle WIllow Smith%20(4).jpg)
Everybody Breathes: Treating TB in Eshowe, South Africa
Phenduka Mtshali, a patient with Drug Resistant Tuberculosis (DR-TB), is seen in her home in Mbongolwane, South Africa speaking with MSF fieldworker, Celiwe Dlamini. Phenduka lives in Mbongolwane a rural area of South Africa’s KwaZulu-Natal province at the epicentre of South Africa’s HIV & TB epidemic and where MSF is currently piloting a model of care aimed at upgrading the TB treatment cascade.
Everybody Breathes is a package documenting how the lessons learnt from the initial phases of the ‘Bending The Curves’ initiative in South Africa are now being used by MSF in Eshowe to tackle TB. The package will document interventions the project is putting in place in collaboration with its partners to prevent the spread of TB, provide a link for patients to get tested, locate missing cases and ensuring patients remain on treatment with structures that fit into their lives. Photographer: Tadeu Andre%20(4).jpg)
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