When Whole Becomes Greater Than The Sum Of Its Parts

By Bobby Ramakant, Citizen News Service – CNS
Health When Whole Becomes Greater Than The Sum Of Its Parts

Earlier this year we had visited many biosafety level (BSL) III laboratories in India where one of the latest diagnostic tools were available to do drug susceptibility testing (DST) for tuberculosis (TB). One red-coloured sticker on these diagnostic tools caught our attention: UNITAID. This organization not only raises 70% of its core funding by innovative financing mechanisms such as by levying a small fee on airline tickets, but also has made a difference differently when compared with other traditional donors.

Dr Denis Broun, Executive Director of UNITAID said at the global launch of largest-ever roll-out of Gene Xpert MTB/RIF that one of the priorities is, to get better and innovative products at lowest possible price for everyone (not just UNITAID). For example in Myanmar UNITAID has financed only four out of nineteen Gene Xpert machines working presently but the negotiated lower prices of these machines and its cartridges are available for everyone around the world. "Our priority was that the prices we negotiate are able to be available for everyone everywhere" said Dr Broun.

The cost of Gene Xpert machine and cartridges had come down after successful negotiations were held by US Agency for International Development (USAID), US President's Emergency Plan For AIDS Relief (PEPFAR), UNITAID and Bill and Melinda Gates Foundation with the manufacturer, Cepheid. The cost of cartridges of Gene Xpert came down by nearly 42% to USD 9.98 (from USD 17) and cost of Gene Xpert machine came down to USD 17,000 (with desktop) or USD 17,500 (with laptop).

This significant price reduction directly increases utilization of these diagnostic tools for TB and rifampicin drug resistance testing because we get more value for every penny spent globally. "We did not install any machine in South Africa or Brazil but they are getting the same price we negotiated" said Dr Broun. In Brazil, Gene Xpert MTB/RIF machines are being used in prisons to diagnose TB (and multidrug-resistant TB or MDR-TB) accurately within two hours.

Innovating financing of UNITAID makes focussing on delivering sustainable and high impact outcomes possible. Eleven countries have set up tax on air-tickets to finance UNITAID since 2006, said Dr Broun. He continued to share that, a litmus test of this innovative financing mechanism was, when other development aid was severely hit by recession, but not UNITAID.

Dr Broun shared another success story where UNITAID has made a difference: paediatric drugs for children living with HIV and/or co-infected with TB. It was toughest to convince the manufacturers to produce paediatric fixed dose combinations (FDCs), said Dr Broun. TB is so under-diagnosed and treated in children. "Result has been that half a million children were on treatment and price per child reduced by fourth" said Dr Broun. Progressively financing for paediatric drugs has come through the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), PEPFAR, among others. UNITAID is working closely with Global Alliance for TB Drug Development (TB Alliance) to develop new effective anti-TB drugs for children.

Similarly UNITAID has been working on reducing prices of Artemisinin Combination Therapy (ACT) to treat malaria and has financed more than three million treatments so far. Myanmar has a policy against the use of mono-therapy in treating malaria and fully backs ACT.

Dr Min Than Nyunt, Director General, Department of Health, Myanmar said to Citizen News Service - CNS that Foundation for Innovative New Diagnostics (FIND) and UNITAID have helped strengthen laboratory capacity in the country. Now, there are two reference laboratories (national TB reference laboratory in Yangon and regional TB reference laboratory in Mandalay) which are fully equipped with BSL III laboratories and latest TB diagnostic tools such as Gene Xpert MTB/RIF, Line Probe Assays (LPA), liquid and solid culture testing, among others.

Dr Erwin Cameroon of the World Health Organization (WHO) said that even the TB funding has increased twenty times over the last few years in Myanmar.

Dr Fuad Mirzayev of the WHO Global Tuberculosis Programme said that these [Gene Xpert] tests create an opportunity to provide treatment if systems are in place. 1400 Gene Xpert machines are already put in use in 88 countries. Three million cartridges have been used in these Gene Xpert machines from December 2010 till end of 2012. UNITAID has invested USD 25.9 million to purchase over 220 GeneXpert machines and 1.4 million test cartridges for 21 countries in Africa, Eastern Europe and Asia. Coordinated by the WHO and the Stop TB Partnership, this project - known as TBXpert - is estimated to save an additional 62,000 lives by helping test 22,000 MDR-TB cases and 143,000 TB cases.

Dr Thandar Lwin of the national TB programme in Myanmar said that TB mortality rates have halved already but prevalence rates need to go further down to meet the Millennium Development Goals (MDGs) by 2015. About 10% of TB patients are co-infected with HIV.10% of previously treated and 4.2% new TB cases are estimated to have MDR-TB. Dr Lwin shared that Myanmar is aiming to reach 100% case detection rate of MDR-TB among previously treated TB cases and 50% case detection rates among new TB cases by 2018.

Myanmar is also moving towards achieving 100% HIV testing of TB patients. Pointing towards continuous need of supplying enough cartridges for Gene Xpert machines in Myanmar to test TB and MDR-TB, Dr Lwin said that 6044 cartridges are needed in 2013, 6688 cartridges will be needed in 2014 and 14,500 cartridges will be required in 2015. Dr Lwin also drew attention to increase domestic funding for TB control and care for sustainability.

Diagnosing TB early and accurately is very important part of TB control and care and providing standard quality-assured treatment is another important part, among others. Ensuring uninterrupted supplies and strong logistical support and financial mechanisms are equally important.

Finding innovative ways, such as those of UNITAID, to provide more effective, value-added and sustainable solutions is indeed helping in enhancing public health outcomes. (CNS)

Bobby Ramakant, Citizen News Service - CNS

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