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To protect against antimicrobial resistance, focus on saving lives from tuberculosis

by Jaak Peeters | Johnson & Johnson
Friday, 17 November 2017 14:00 GMT

A doctor points to an x-ray showing a pair of lungs infected with TB (tuberculosis) during an interview with Reuters on board the mobile X-ray unit screening for TB in Ladbroke Grove in London January 27, 2014. REUTERS/Luke MacGregor

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

If we all band together and do our part to stop TB, we can do the same to protect the world’s supply of life-saving antibiotics

Over the past couple years, the challenge of antimicrobial resistance (AMR) – the emergence of diseases that can no longer be cured by existing medicines – has received unprecedented global attention. Last September, the United Nations warned that failure to form a coordinated global response would pose a fundamental threat to human health, development and security. When the G20 countries met this past July, they issued a declaration to support each other in developing national action plans against AMR.

For concern to translate into action, there is much to be done by everyone involved, including governments, health care professionals, civil society and industry. We have an opportunity to accelerate progress this week when the global community meets in Moscow to focus on tuberculosis (TB), a disease that caused more than 1.7 million deaths in 2016 and remains the world’s leading infectious killer. Globally, drug-resistant TB accounts for one-third of the antimicrobial resistance burden. If we can take a holistic approach in turning the tide on TB, we can begin to turn the tide on antimicrobial resistance overall.

To better understand the link between TB and AMR, consider the experience of Mumbai, India. In 2016, thousands of residents in the city had a form of drug-resistant TB that would not respond to traditionally used medications, leaving them with no choice but to endure a two-year treatment consisting of 14,000 pills. Unsurprisingly, many patients do not, or cannot, finish the full course. In these patients, the disease can adapt and build resistance to the drugs used in their treatment, increasing the spread of AMR.

Fortunately, there is a lot we can do to stop TB, and countries like India are working with a range of stakeholders to drive progress. Strategic use of medicines, diagnostics and preventive strategies has saved an estimated 53 million lives over the past 15 years, inspiring the World Health Organization to set an ambitious goal of reducing TB deaths a further 95% by 2035. The global “End TB Strategy” calls for ensuring universal access to needed drugs and diagnostics; creating regulatory frameworks for quality and rational use of medicines; and investing in research and development.

Ever since the discovery of streptomycin treatment in the mid-1940s, industry has been a partner in the fight against TB. Today, we are being called on to stay involved, and do more, because not all of the drugs and tools we need exist. When our company, Johnson & Johnson, first introduced a new treatment for multi-drug resistant TB in 2012, it was the first new FDA-approved drug to treat TB in over 40 years.

To bring an innovation that had the potential to impact hundreds of thousands of lives for the better was an inspiring moment for our company. It also signified that industry is on the cusp of a new era of innovation for TB, as several new treatments have been identified that could lead the way toward shorter, safer regimens for patients with drug resistant TB.

But our experience with bedaquiline taught us that it is not enough to just develop new medicines to tackle DR-TB.  To have any actual impact, our commitment to developing innovative medicines needed to be matched by innovative pathways to accelerate access and appropriate use.  

Since 2012 we have worked with governments and health partners to put in place those pathways, which has not only accelerated access to our MDR-TB treatment, but has also ensured this new drug is used appropriately and that over 30,000 patients have been given a chance at a cure.  Our experience has underscored the importance of working collaboratively to address all systemic failures, not only the failures in discovery and R&D, but also in financing, regulatory approval, diagnostics, treatment capacity, and country coordination.  

We desperately need a new operating model, based on shared goals, responsibility and accountability, to solve the burden of DR-TB and the broader AMR challenge. It will take a sustainable ecosystem built around appropriate financing, incentives, stewardship and in-country transparency and performance management to support the rapid acceleration of progress against DR-TB and AMR.  

I’ve seen first-hand how public-private collaboration in other areas, like HIV and maternal health, can have a major impact.  And I believe we can replicate this model for TB, and apply lessons learned to the broader challenge of antimicrobial resistance.  We will continue to invest in innovation and development of such an ecosystem as we head to Moscow to champion a shared agenda for action on TB and antimicrobial resistance.

I’m convinced that if we all band together and do our part to stop TB, we can do the same to protect the world’s supply of life-saving antibiotics.

Jaak Peeters is the Head of Global Public Health for Johnson & Johnson.