Never bring a knife to a gunfight. And yet, the global tuberculosis (TB) community has been doing precisely that for decades – fighting a protracted battle with antiquated, inefficient tools, including an insensitive diagnostic (i.e. sputum microscopy), a low-efficacy vaccine (i.e. BCG), and drug regimens that have hardly changed for decades.
Fighting a battle with outdated tools has cost us dearly. Last year, the WHO declared that the TB epidemic was worse than previously thought, with an estimated 10.4 million new TB cases in 2015. And, despite being a curable infection, 1.8 million people died from TB in 2015, making TB a bigger killer than HIV and malaria combined.
At long last, new diagnostics and drugs have emerged. For diagnosis, we have innovative rapid technologies, including the Xpert MTB/RIF (GeneXpert) test that can rapidly detect TB as well as drug-resistance. For treatment, two new drugs, delamanid and bedaquiline, are now approved for drug-resistant TB), in situations in which there is resistance or intolerance to the other second-line agents or a high risk of treatment failure.
So, we, the TB community, asked for new tools, and new tools have been successfully introduced and policy endorsed. But we are now learning the hard way that availability does not necessarily result in widespread access. In an analysis published in eLife this week, we (Jennifer Furin & Madhu Pai) summarized the uptake of new tools such as GeneXpert, bedaquiline and delamanid, and identify the main barriers to scale-up and patient access. In an accompanying blog post in Huffington Post, we have summarized our eLife analysis and provided some constructive solutions. Do let us know what you think!