IN THE SMALL, DUSTY, DISTRICT HOSPITAL IN TEMEKE, TANZANIA, head nurse Sarah Wilson Ochogo is carrying out her morning ritual. She drags a table outside the hospital's tuberculosis (TB) unit, sets out big, white, plastic bottles of pills, and opens a pencil-lined ledger that tracks her patients, their drugs, and their doses. By seven, more than 100 patients are lining up. They place their green patient cards under a stone near the table, and sit down on wooden benches to wait until Ochogo calls their name, gives them their medication, and watches while they take it. By a bit after nine, the patients are off to their daily routines—drawing water, tending crops, or just getting by the way people always have in Africa. And all of them, with luck, are one more day closer to curing their TB.
TB Incidence Rate
Throughout Africa—indeed, throughout the world—the same ritual is taking place, as healthcare workers deliver TB drugs to millions of patients spanning countries, languages, and cultures. It's called DOTS—"directly observed short-course treatment"—and it is the internationally recommended strategy for TB control, put forth by the World Health Organization (WHO). Patients in DOTS take a two-month daily course of the antibiotics rifampacin, isoniazid, pyrazinamide, and ethambutol, followed by either four months of rifampicin and isoniazid, or six months of isoniazid and ethambutol.
Certainly, the DOTS strategy aims high: to ensure that patients take their drugs in the same, correct way and for the full course of treatment. That's partly to ensure that they recover—but partly to protect against half-completed treatment that gives rise to mutated, drug-resistant strains of the disease, which are more difficult and expensive to treat.
When we think of TB epidemics, we tend to think of the past, especially the great epidemic that swept Europe in the 19th century. But in fact, TB is one of the world's great killers again: Two million people die each year from the disease. WHO estimates that more than two billion people worldwide, or one third of the world's population, carry at least a latent TB infection. And the AIDS epidemic is making it worse. TB accounts for a third of AIDS deaths worldwide; the co-infection is commonly referred to as the "deadly duo." In 2004, an estimated 14 million people were living with dual HIV and TB infections. Seventy percent of them were African.
From AIDS to TB
Drugs are available and cheap—a six- or eight-month course of treatment procured through generic Indian manufacturers costs about $10. The guidelines for DOTS administration are well known. The supply-chain management for the procurement and administration of the drugs is in place, with tight controls to prevent diversion. There's just one problem: It isn't working. Millions have died and millions more are dying. And in the past few years, pharma companies have discovered that there is a real role for them to play in fighting TB. Several factors play into that realization:
Globalization is transporting diseases from one part of the world to others. That has already happened with TB in New York City, where infected immigrants are thought to have contributed to the resurgence of the disease in the late 1980s.
- TB is a death accelerator of AIDS patients, making it a global health priority, and a target of the United Nation's Millennium Development Goals. The public and other stakeholders will likely exert pressure on the industry to contribute its technical and public-health expertise.
- The growing number of bacteria resistant to today's TB therapies has given pharma a clear-cut role of bringing its unique skills in drug discovery to the table.
- Academics and nonprofits are settling into a new way of partnering with industy that allows them less costly and risky ways to participate in the search for new TB drugs.
- Governments and other third parties will increasingly look to pharma's infrastructure initiatives, many of which were established to fight AIDS, to help manage the TB burden.