The cost of TB drugs in Africa

For once this can be initially seen as good news, although good news with an ironic and tragic twist.

The cost of first line drugs

Just over a decade ago, a course of first line drugs for TB cost around $200. According to MSF in 2011,  thanks to pressure from the WHO the same course in South Africa costs just $19. This is clearly progress, in that it enables affordable treatment.

These drugs normally are purchased by the Global Fund ensuring that they are from an approved supply, although even this pipeline is at risk, evidenced by a complete breakdown in TB drug supply in Uganda for three months in 2012, with no first line drugs available in the country for this period - a recipe for drug resistant disease.

The cost of second line drugs

This is of a quite different order. MSF estimate that it costs between $4,700 and $9,000 per patient with MDR-TB in South Africa, a cost that is patently unaffordable for most of the continent. With XDR-TB the costs may be even higher with less chance of success. MSF also provided evidence of profiteering on the part of the manufacturers despite the fact that all approved TB drugs are well out of patent - something which bears witness to the fact that most drug companies simply do not want to involve themselves in the manufacture of these drugs. 

In 2000 the WHO set up its "Green Light Committee" to ensure that subsidised quality-assured second line drugs could be supplied to patients with MDR-TB. It was estimated in 2011 that just 0.5% of all MDR-TB patients are actually being properly pharmaceutically treated. The system is quite clearly failing.

Dr Unni Karunakura, the President of MSF has gone on record: "Whenever we [actually] look for drug resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem."