Tuberculosis Advocates Push for Cheaper Tests

Dozens of tuberculosis (TB) activists took to the stage during the opening of the annula World Conference on Lung Health in Bali, Indonesia, to demand that the price of GeneXpert tests to detect TB is slashed to $5 in low- and middle-income countries. ​

Medical test maker Cepheid and its parent corporation Danaher were asked to reduce the price of GeneXpert tests to US$5 in low- and middle-income countries. ​

While Danaher reduced the price of the standard TB test by 20% in September 2023 from $10 to $8, the test used to detect extensively drug-resistant TB, remains very high at $15.

Research commissioned by Medecins Sans Frontieres (MSF) in 2019 shows that GeneXpert cartridges could be produced and sold at a profit for less than $5 each, said MSF in a statement on Tuesday.

“For the majority of their tests, Cepheid and Danaher continue to charge triple the $5 that they could be selling each test for and still make a profit. This is unacceptable profiteering by the corporations, especially considering Cepheid and Danaher received $252 million in public funding to develop these tests,” said MSF Access Campaign’s diagnostics advisor Stijn Deborggraeve.

“The corporations have also not kept their promise to share an annual audit of their prices that they committed to more than one year ago. Cepheid and Danaher, it’s really time to do the right thing – it’s time for $5 for each GeneXpert test.” ​

The price of the test is important as TB is once again the world’s leading infectious disease killer after a few years of trailing COVID.

Impact of climate change

Climate change and migration are exacerbating the prevalence of TB while “poverty has made it very difficult to reach all patients who may have tuberculosis,” Marian Wentworth, CEO of global non-profit Management Sciences for Health (MSH) told Health Policy Watch. “Connected to that is weak health systems that contribute to the problem as well,” she added.

Some studies have shown that TB infections are rising as temperatures rise, but more research is needed.

Around 3,900 people from about 150 different countries are attending the lung conference organized by The Union, a global health organization that works to eliminate TB.

The world is far from meeting the World Health Organization (WHO) targets for 2025 and 2030, according to its End TB Strategy.

In 2023, there were around 8.2 million new TB cases, according to this year’s World TB report, and 1.25 million deaths.

Survivors demand person-centric care

Chapal Mehra, convenor of Survivors Against TB, said that there is a big gap between what the health system thinks is good quality person-centered care, and what a patient believes is good quality person-centered care.

Patients are often less worried about the side effects of TB than pressures like poverty or caregiving responsibilities, he explained.

While survivors get invited to panel discussions they are not involved in policy and decision-making, he added.

“There are a lot of new plans and ideas on how to work with TB-affected communities, but there isn’t enough [patient] involvement in research, in product development. Because what happens is that they develop a product first, and then they come to us and say: Can you make it acceptable to communities?” he said.

This is something the organizers are trying to bridge, they said.

“TB is a social disease. Without community, you cannot cure TB,” said  Zahedul Islam, Chair of The Union’s Community Advisory Panel, who is coordinating an initiative called the Community Connect at the conference.

“With Community Connect, we are trying to bring in the scientific community and build collaboration and foster partnerships with the community,” he told Health Policy Watch.

Gendered impact of TB

Women make up around a third of all TB cases but often lack the social support or access to resources that male patients might have. They are also less likely to seek care for themselves and face delayed diagnosis even when they do.

“We work in Afghanistan, so that’s a very obvious challenge when women can only seek care through other women, right? And it’s difficult to actually strengthen the capacity of women in a country that doesn’t really encourage women working,” said Wentworth.

Women in Afghanistan have been banned from working in aid organizations including the United Nations by the Taliban. The rules are also rapidly changing and being updated making it hard to reach women in the country.

Mehra says that women need different care and a different setting to men, as TB treatment can affect women’s fertility while the stigma can affect their marriage prospects, and a care provider has to be sensitive to those needs.

He added that trans people with TB often get ignored, and this is an issue that a panel he is a part of at the conference would be shining a spotlight on.

Mental health and climate change on the agenda

“We have special sessions on climate change and its impact on TB and the delivery of TB services,” said Carrie Tudor from The Union who is coordinating the development of scientific programme of the conference.

“People with TB suffer depression, stigma and other mental health issues, so making sure that that is more recognized and raising awareness about mental health and TB,”  said Tudor.

The conference is taking place in Indonesia, which accounts for 10% of the world’s TB burden. India (26%), China (6.8%), the Philippines (6.8%) and Pakistan (6.3%) are the other four countries with high TB burdens. These five countries together account for 56% of the world’s TB cases.

Wentworth of MSH is hopeful that greater engagement will help countries to learn from each other’s scientific research and technologies.

“Given all the new technologies and resources to combat TB, I don’t think there’s been a more important time to have a meeting like this to try and figure out what those technologies mean in terms of real-world action,” she said.