Urgent call for Europe to improve treatment access for TB

Berlin, 6 June 2024: As the World Health Organization (WHO) concluded a meeting with European health officials and civil society to improve access to tuberculosis (TB) medicines in the European Union (EU)/European Economic Area (EEA), Médecins Sans Frontières/Doctors Without Borders (MSF), along with TB activists, urge European countries to maintain this momentum by taking immediate actions to remove barriers impacting access to TB medicines and update policies and practices in line with WHO treatment guidelines. Specifically, MSF urged policy makers and relevant health departments at national and regional levels to jointly coordinate efforts to:  

• Ensure access to newer TB medicines at affordable prices for all EU/EEA countries, either through existing initiatives or by undergoing joint negotiations with suppliers; and 
• Facilitate the registration of all TB medicines in EU/EEA countries, while also ensuring their timely commercialisation using existing legal flexibilities and communicating the demands to manufacturers 

“Twelve years ago, my only chance for a cure for drug-resistant TB was to take medicines that need to be injected and had severe side effects like psychosis and constant nausea, and even then, I had less than a 50% chance of healing,” said Stefan Radut, drug-resistant TB survivor and board member of TB Europe Coalition. “I lost half my hearing due to the toxic cocktail of drugs I had to take and half my left lung due to the low effectiveness of the treatment. Today, there are very effective oral treatments available, but people are unable to access them. People are faced with the fact that the medicines they need simply are not available, or if they are, people have to stay in hospitals up to 300 km away from their home as local clinics can't procure the medicines they need. It is completely unacceptable that these newer, all-oral and more effective medicines offering a much higher chance of cure are still not accessible and affordable for people who need them.”

In 2022, MSF began responding to the needs of refugees arriving in Poland and Slovakia from war-torn Ukraine, including by supporting the substantial amount of people who were affected by TB and its drug-resistant (DR) forms. However, it was soon clear that Poland and Slovakia were not well prepared to respond to TB, with limited designated medical infrastructure, outdated standards for testing, treatment and prevention of TB, and a lack of integration of WHO guidelines into national health policy. This lack of preparedness is seen across most other EU/EEA countries, where newer and existing drugs, including all-oral treatments for DR-TB recommended by the WHO, child-friendly formulations, and shorter preventive TB treatments – most of which are largely available in lower- and middle-income countries – remain inaccessible in most EU/EEA countries due to high prices or lack of registration. 

For instance, the WHO-recommended six-month, all-oral treatment regimen for drug-resistant TB, consisting of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM), costs over €40,000 in many EU/EEA countries, while it is available for €380 in lower- and middle-income countries through the Global Drug Facility, an international TB drug and diagnostic procurement mechanism. 

"When we started to support people with TB in Poland in 2022, we were appalled by the fact that newer and more effective treatment regimens that have been available in high TB burden countries for many years were simply not available in Poland,” said Joanna Ladomirska, MSF’s Medical Coordinator in Poland. “In Poland and many other EU countries, access to newer, more effective TB drugs has been limited or is completely non-existent. Children still endure bitter, inaccurately dosed medicines, and even those with non-resistant forms of TB must take 11 pills a day instead of the three pills a day in fixed-dose combination available elsewhere. Eliminating TB in Europe will remain a distant dream unless this treatment access gap is closed. We urge European countries to continue their past efforts to eradicate TB and take immediate action to provide the best and most advanced TB treatment and care to people who need it."

Recognising the growing increase of TB and its resistant forms in many EU countries, WHO convened a meeting in 2022 to identify gaps and suggest solutions. However, there has been little progress at the regional or national level in ensuring access to WHO-recommended medicines and addressing supply issues. 

"European governments can't afford to lag behind, putting decades of progress at risk and losing lives that could be saved with timely access to effective TB treatments, said Christophe Perrin, TB Advocacy Pharmacist with MSF’s Access Campaign. “It's high time Europe puts TB back on the health agenda and commits to real, tangible solutions. People with TB in Europe have waited long enough."

Source: Médecins Sans Frontières