'Lifetime Achievement' and 'IDRF Gold Medal Oration' Awards

In an effort to increase awareness regarding diabetes among the common public and as an advocacy incentive, the India Diabetes Research Foundation (IDRF), established by Prof A Ramachandran in 2007 in Chennai, has instituted two awards, to honour eminent people who have made significant contributions in the field of diabetes. Read more

This year Dr. Ala Alwan, Assistant Director, Non-communicable Diseases and Mental Health, World
Health Organization, Geneva, received the ‘IDRF Gold Medal Oration’ Award and Dr. Anil Kapur, President, World Diabetes Foundation, Denmark, was honoured with the Lifetime Achievement Award, in a ceremony organized recently in Chennai.

Both of the recipients are well known figures in the field of diabetes.

Dr Alwan has held several positions in clinical and academic medicine and public health. He has been occupying his present position since February 2008 and was earlier Professor and Dean of the Faculty of Medicine, Mustansiriya University, Baghdad. . Prof Alwan's research interests are screening for non-communicable diseases, reforms in health sector for human resource development and prevention of diabetes and cardiovascular diseases. He has published many research papers in prestigious international medical journals and has played a major role in the formulation of international guidelines and international care initiatives of the WHO.

Dr. Anil Kapur is the President of World Diabetes Foundation, Denmark. He has been associated with the World Diabetes Foundation since its inception, previously serving on its board as the vice chairman. He initiated the development of several programmes, especially public awareness campaigns, in diabetes as part of this Foundation. He has also authored nearly a hundred research publications in the areas of Internal Medicine, Clinical Pharmacology, endocrinology and diabetes. He has coordinated several large studies and developed a nutritional software package called NINA.

While receiving the award, Dr. Alwan rued that Non-Communicable Diseases (NCDs), including diabetes, had become the single biggest cause of mortality by accounting for 60 per cent of the 35 million deaths occurring globally every year.  He pinpointed that the three major drivers of the rapidly changing profile of this disease, which is impacting health and socioeconomic development in developing countries, were aging population, unplanned urbanization, and globalization of unhealthy environments/ behaviour.

Health systems in developing countries, with an estimated 10 million deaths due to NCDs annually, have been reeling under the cost impact of managing the NCD burden. The WHO global strategy for NCDs laid down a framework for tobacco control, diet modifications, physical activity and health promotion, Dr. Alwan said.

In his speech, Dr. Kapur noted that in several remote regions across the world, diabetes was seriously impacting on the lives of the poor who lacked awareness and resources to cope with the condition. According to him, NCDs such as diabetes should be seen not as a clinical problem but as a public health issue requiring multi-sectoral intervention.

Dr Ramachandran, IDRF president, felt that the low and middle income families were worst hit by diabetes. He said that surveys showed that the cost of caring for a diabetic member of the family in poor households had risen from 20 per cent a few years ago to almost 35 per cent of family income.

We must remember that diabetes is a major epidemic all over the world. The pandemic of diabetes in developing countries like India and in underdeveloped countries is associated with high mortality and increased health care cost, creating several implications on the overall status of the society. It is estimated that globally 3.8 million people die due to diabetes.

All of us can help in the fight against diabetes in different ways – by creating awareness about the disease; promoting factors leading to its prevention and complications; educating and training healthcare professionals and people living with diabetes; finding better  tools for the detection, treatment and control of diabetes.


Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. 
Email: shobha@citizen-news.org, website: www.citizen-news.org)

Repatriate 100 Indian fishermen whose sentence is over: Pakistan's Court

As per reports from civil society groups, Supreme Court of Pakistan has agreed to release 100 Indian fisher-people whose sentence is over. It is indeed a landmark judgment from Pakistan and Indian judiciary is encouraged to reciprocate this gesture of at least, releasing those Pakistani fisher-people and other citizens whose sentence is over. Earlier there were reports that the Pakistan's Supreme Court had informed 454 Indian fishermen (out of total 582 currently detained) have completed their sentences in Pakistani jails, should be repatriated. Read more


Pakistani ministry of Foreign Affairs had earlier told Supreme Court that four hundred and fifty four (454) Indian fishermen (out of total 582 currently detained) have completed their sentences and that they have been verified to be Indian nationals by the Indian high commission in Pakistan. Foreign Affairs has recommended to the Interior ministry to expedite their repatriation to India. Thankfully the milestone was set when the Supreme Court allowed 100 Indian people who have finished their jail term to be repatriated and released.

India should reciprocate this gesture, which is long over-due for those Pakistani people in Indian jails whose jail-term is over - we must release them and repatriate them, said Indian activists.

Bobby Ramakant - CNS

Repatriate Indian fishermen after sentence is over: Pakistan's Supreme Court

Supreme Court of Pakistan informed 454 Indian fishermen (out of total 582 currently detained) have completed their sentences in Pakistani jails, should be repatriated. Pakistani ministry of Foreign Affairs told Supreme Court that four hundred and fifty four (454) Indian fishermen (out of total 582 currently detained) have completed their sentences and that they have been verified to be Indian nationals by the Indian high commission in Pakistan. Foreign Affairs has recommended to the Interior ministry to expedite their repatriation to India. Read more



Supreme Court of Pakistan bench, comprising Chief justice Iftikhar Mummad Choudhry and Mr justice Khalil-u-Rahman Ramday was hearing a constitutional petition filed by Pakistan Fisherfolk Forum (PFF), Pakistan Institute of Labour Education and Research (PILER) and Indian Fishermen detained in various jails in Sindh (Pakistan) against unlawful detention of Indian fishermen. Senior advocate Syed Iqbal Hyder appeared on behalf of petitioners.

At the hearing the apex court gave one more chance to the Interior ministry to submit their explanation before the next hearing on 14 September 2010 immediately after the festival of 'Eid.'

On the last hearing on August 12, 2010 the Supreme Court had directed the ministry of Foreign Affairs, ministry of Interior Government of Pakistan and Government of Sindh (Pakistan) to submit their Para-wise comments to the petition and explain under what lawful authority the Indian fishermen in question were arrested, prosecuted, convicted and later detained for so many years.

At the hearing the ministry of Interior and the Government of Sindh (Pakistan) did not appear before the court. However the ministry of Foreign Affairs gave its detailed comments, agreeing the contentions of the petition.

Syed Iqbal Hyder presented to the supreme court the two orders passed by the Indian Supreme Court in similar cases, these orders were obtained with the help of Indian Human Rights activists. The Pakistani apex court has taken into consideration the orders of Indian Supreme Court which support the contention and the issues before the Pakistan Supreme court for the release of Indian fishermen.

Syed Iqbal hyder termed the comments filed by the ministry of foreign affairs and its recommendation for release of Indian fishermen as very encouraging and heartening. The foreign ministry has also produced a detailed account of the number of the prisoners released by the two countries in the recent past. It has also acknowledged recent release of Pakistani prisoners in pursuance of the orders of the honorable Supreme Court of the India.

A media advisory in this regard was issued by Shujauddin Qureshi, Senior Research Associate, Pakistan Institute of Labour Education and Research (PILER).

Bobby Ramakant - CNS 


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TB response for women is grossly inadequate

Poverty is major driver of TB

[To listen to audio recording/podcast of CNS Exclusive interview with Dr Ann Ginsberg, click here]
In developing countries TB remains the third leading cause of death among women of reproductive age (15-44 years), disproportionately affecting pregnant women and the poor. This calls for immediate action to address the suffering caused by TB and to eliminate the disease as a leading killer of women. Read more

According to Carol Nawina Nyirenda, a patient advocate, "As women, we usually carry the dual burden of being infected and at the same time caring for our infected and affected family members and loved ones."

Diagnosis and treatment of TB presents a unique challenge in the case of women, due to biological differences and gender inequalities. While men are more likely to have latent TB, women are more likely to develop the active disease. Poverty is a major factor for developing active TB, and as women account for 70 percent of the world’s poor, they are disproportionately affected by the disease.

According to Dr Ann Ginsberg, Chief Medical Officer at TB Alliance, who is also part of the Board of Directors of Aeras Global TB Vaccine Foundation, TB has a profound effect on women and their families. The burden of the disease is obviously more on the woman of the house. She has to bear the physical, mental and economic trauma of the disease. The woman may be sick herself or have sick children or a sick husband to take care of them. Women suffering from TB are often unable to care for their children and have trouble performing household chores. They may have to walk miles to get the treatment which has severe side effects. The health of children with an infected mother is also greatly affected. In addition there is no one to bring money in the family, as the disease leads to a loss of work and loss of wages. So the women end up taking the brunt of much of that.

Women's social roles/status places them at a higher risk of contracting TB. Cramped and unhygienic living conditions and poor nutrition levels facilitate the spread of the disease. In developing countries, women often cook indoors, in confined spaces, using biomass fuel. Studies show that they are more likely to develop active TB, as the smoke from such fuels can weaken the respiratory systems and impair the immune system’s ability to fight off bacteria.

Poor women are also at an increased risk of being coerced or forced into sex work. Millions of women are forced into commercial sex work each year, especially in the developing countries. They are then at an increased risk of contracting TB, as also HIV from their clients.

TB also poses a considerable risk for pregnant women. Discontinuing TB medication prematurely is hazardous to pregnant women and their babies and can lead to the development of drug resistant TB. If left untreated, women may transmit TB to the newborn infant.

Women suffer much more from the impact of TB, due to stigma and discrimination, coupled with a lower socio-economic and educational status in low-income countries. Very often they are afraid to reveal their ill health to their family and community members. Positive TB diagnoses may force women into divorce and/or, make them unsuitable as a marriage partner. In India, even in well off families, women are programmed to put family above self. They traditionally eat last, of whatever is left, and often neglect their illness until they become too sick to lead normal lives. 

All these factors prevent women from timely accessing qualified health services, causing delays in treatment and the continued spread of disease.

Even clinically, TB in women is more difficult to diagnose, perhaps due to biological differences, as indicated by studies in several countries. On top of this, social factors compound the problem in some regions. A study in Pakistan reported that women felt uncomfortable producing the mucus needed for sputum-smear microscopy, the standard diagnostic test for TB in resource-limited settings. Some women used saliva instead, which greatly affected test results.

A lack of political will, inadequate financing, poor information about the disease and social stigma remain barriers to reducing the burden of TB among women. Routine TB screening should necessarily be incorporated into maternal and child health programs in countries where TB is endemic.

Dr Ann Ginsberg feels that the current TB regimen is too long and complicated for patients to follow. It is crucial that we have new treatment regimens which are shorter, simpler, and hopefully better tolerated by the patient. Only then can we save the lives of millions of women and reduce the burden the disease has on their families.

Developing even a single drug takes as long as 10 or even 20 years in case of TB. But we are looking here for new multi drug regimens. The goal of the new CPTR Initiative is to bring together the sponsors of these different new drugs that are in the development stage, the regulatory authorities, and other key stakeholders, including funders, to really change the paradigm of the clinical process. In this way, instead of having to develop multiple new drugs one at a time (which may take decades before we have a better drug regimen), one can go from pre clinical development to approval of a new regimen in a few years. New drugs will impact in many ways on eradication of TB. They would especially impact the lives of women and children in a positive way.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. 
She is supported by Global Alliance for TB Drug Development (TB Alliance), the Bill and Melinda Gates Foundation, the Stop TB Partnership Working Group on New Drugs, Treatment Action Group (TAG) and CNS to write from Addis Ababa, Ethiopia from the Open Forum-4. Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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Rural child health initiative reaches out to UP's poor

Photo credit: Kulsum Mustafa

Wednesday and Saturdays are Routine Immunization days in Uttar Pradesh. From morning one witness rural women with infants in arms making a beeline for primary health centres. But June and December are more special months for little children in India's most populous state with very poor development indicators. It is in these two months when health call beacons all the under five in remotest corners of the state. Read more




"Bal Swasthya Poshan Mah" (BSPM) is a bi-annual government health programme that addresses the grave issue of malnutrition from which a major number of the state children suffer. During BSPM children are given the vital vitamin A dose the deficiency of which can result in preventable blindness.  The children also get the routine immunization (RI). During BSPM counseling of young mothers, pregnant and lactating women is also done regarding the right nutrition for their children which includes breastfeeding, complimentary feeding, supplementary feeding, usage of iodine salt, and proper sanitation.

While this health initiative is for all the 72 districts of Uttar Pradesh, special focus is being given on 15 districts which have been identified as 'high risk (HR).'

Farrukhabad, situated some 250 km from the state capital Lucknow is one such HR districts. The UP government has taken the help of UNICEF for this.

"The high risk district generally have a high density of Muslims and lower castes, the idea is to reach out to them and ensure that they are not left out in this health campaign," explained UNICEF medical representative Dr Deepak Sinha in the district.

"Kamaalganj, one of the six blocks in Farukkabad district has 50 per cent Muslim population. Thus efforts have been made to reach out to them through the leading Muslim persons in the area," he explained. Dr Tausif Baig, district coordinator, Farukkahabad, Social Mobilizing network, UNICEF said that they are going from door-to-door with a team to explain to the population the advantages of availing of the facilities during the BSPM.

He informed that their initiative of getting the publicity material printed in Urdu has got a lot of good response.

The team is also ensuring that reach out to the minority community during the weekly Friday congregations.

One can only hope that concentrated and sustained efforts will bear fruit and the community comes forward to avail of the health facilities being offered free of cost to them like to people of other community.

Kulsum Mustafa
(The author is a senior journalist and also the Secretary of Media Nest) 


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Fighting TB With Community Support Can Transform Lives

To download or read the Patients' Charter for TB Care click here
The necessity of involving common citizens in the ongoing battle against TB was discussed at the recently concluded Open Forum 4: Critical Path to TB Regimen: New Hope of Life for TB Patients in Addis Ababa, Ethiopia. Read more




TB kills nearly 2 million people every year, 98% of whom are in the developing world.


TB is the leading cause of death among people living with HIV; and nearly one third of all reported cases are TB/HIV co-infection. TB accounts for almost 20% of all deaths and 26% of all preventable deaths in the age group of 15 to 49 years –the most economically productive age group.


Africa has a very disproportionate burden of TB. It is home to 12% of the world’s population but 30% of the world’s burden of TB. 9 of the 22 high burden countries are situated in Africa alone.


Sincere community involvement at all stages is thus crucial in the fight against this deadly disease-- right from the development of new treatments to making them available to those in need of them.


The impact of TB is not confined to the patient alone; illness of an adult can affect the quality of children's lives as well. TB contributes to the socioeconomic deprivation of families and communities, resulting in increased poverty and persistent hopelessness. Weak health systems and inadequate resources are compounding the problem and necessitating community based programmes to tackle the issue.


According to Dr Jeremiah Chakaya, Chair of the Stop TB Partnership's DOTS Expansion Working Group, community participation is at the core of the success of the TB DOTS programme. Health personnel need the help of community care givers in ensuring that the patient does not default from the regimen of completing the full six-month course of treatment, typically involving four drugs. Else, patients might develop drug resistant TB, and in turn create a significantly large pool of infected people.
Patients' Charter for TB Care is another step in the direction of ensuring patient/ community participation in TB care. Dr Chakaya stressed upon the need to empower people and communities for the purpose of advocacy, communication and social mobilization.


To slow down infection rates, several Southern African countries have now launched community-based screening, treatment and care programmes, especially in areas where access to health education and care is limited.


Dr Jane R Ong'ang'o, a Research Scientist at Kenya Medical Research Institute strongly pleaded for  community engagement in TB drug research to make them understand its benefits. She felt it essential to facilitate a dialogue between community members, study volunteers and researchers, and suggested the formation of Community Advisory Boards (CAB), whose members are drawn from religious/civil leaders, women, youth, health workers, policy makers and media.


It is essential to: 
(i) Educate communities about TB disease, treatment and the research process.
(ii) Understand community perceptions and identify community concerns so that they are addressed in the research process.
(iii) Liaise with community stakeholders to facilitate smooth implementation of clinical programs.
(iv) Motivate communities to assist with program/policy change.


Dr Hind Satti, Clinical Director, Partners In Health, Lesotho, talked about the success story of the Community based treatment model for MDR TB, operative in all the 10 districts of Lesotho since 2007. Lesotho has a population of 1.8 million, where 12,275 new cases of TB were notified in 2009. It has a very high prevalence rate of HIV, with 80% of all TB patients being HIV positive.


Adherence to the treatment regimen is crucial to success of TB cure.  But there are many barriers to this adherence, chiefly in the form of socioeconomic obstacles. The Lesotho model has addressed these barriers successfully by means of community mobilization. Currently around 550 patients are enrolled in the community based treatment programme. The treatment supporters come from the community and form a rapport with the affected family. They accompany the patient to all clinical visits, and also provide psychosocial support to the patient and his/her family. They are trained by the local health care centre to observe all drug doses, report any side effects, administer injections, and screen for HIV/TB infections in household contacts.


Dr Satti feels that "Diagnosis and management of all types of TB, including MDR-TB in high HIV prevalence settings is challenging but possible with the help of community - for rapid enrollment and close monitoring of side effects."


Community activist, Nelson Otwama, from Kenya, also believes that the community can help in a big way by educating about the disease, treatment, cough etiquette, reduction of stigma and isolation,
resource mobilization and advocacy to support the adoption of new MDR regimens by national TB authorities.


Another advocacy manager and patient representative, Francis Apina said that community input is a critical component of the research process. It is actually stigma, isolation and quarantine versus community based care. Inadequate patient information and education, social barriers and stigma - all add to the challenges with the current treatment regimens which is increasing MDR-TB.


Francis feels that "current TB drug regimen is inadequate and presents many challenges of treatment; such as pill burden, length of treatment, incompatibility with ARV, non-compliance, the emergence of MDR and XDR-TB. Current treatment is still inadequate to address the challenges of TB/HIV and drug-resistant TB. New tools to quickly diagnose and more effectively treat and prevent TB are desperately needed."


Hence we need community advocates to talk about clinical trials to the voluntary study groups; community mobilizers to help clinical trials to succeed;  community educators to urge people living in infected areas to go for TB/HIV screening; and community care givers to help the patients to strictly follow the treatment regimen and not lose hope, despite all odds.


Only then will the Critical Path To TB Drug Regimens (CPTR) will make an impact by accelerating the development and delivery of new and improved TB treatment regimens, and by sharing data among the CPTR partners promotes an efficient development model that puts patient needs first. New treatments should not become the privilege of a select few, but should be made available to all those in need.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. 
She is supported by Global Alliance for TB Drug Development (TB Alliance), the Bill & Melinda Gates Foundation, the Stop TB Partnership Working Group on New Drugs, Treatment Action Group (TAG) and CNS to write from Addis Ababa, Ethiopia from the Open Forum-4. Email: shobha@citizen-news.org, website: www.citizen-news.org)  


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Tuberculosis And Poverty: Partners By Default

There is a direct link between TB and poverty. It is indeed a vicious cycle, as one begets the other. The stark reality is that tuberculosis saps the economy of the community, which in turn increases the likelihood of contracting TB. This point emerged several times during the recently concluded Open Forum 4: Critical Path to TB Regimen: New Hope of Life for TB Patients, which took place in Addis Ababa, Ethiopia. The meet was organized by TB Alliance with support from the Bill and Melinda Gates Foundation, the Stop TB Partnership Working Group on New Drugs, Treatment Action Group among others. Read more




The economic impact of tuberculosis is staggering. It is estimated to rob the world’s poorest countries of an estimated USD 1 to USD 3 trillion over the next 10 years. 94% of the TB cases and 98% of TB deaths occur in developing countries – and often amongst the poorest in those countries. Also, a large majority of TB patients belong to the age group of 15-54 years, which are the most productive years of one’s life.

The WHO estimates that the average TB patient loses 3 to 4 months of work time and up to 30% of family earnings per year. Entire economies are affected. The burgeoning cost of TB medical care further compounds the problem, putting a constant drain on resource-depleted health systems.

Dr Jeremiah Chakaya, who heads the DOTS Expansion Working Group of the Stop TB Partnership, echoed similar sentiments saying that a partial solution to controlling and preventing TB is to reduce poverty. Economic self sufficiency almost invariably results in healthier diets and better living conditions, which in turn increases the resistance of the body and improves the immune system.

So, a faster and better cure could provide immediate benefits. A shorter drug regimen would reduce lost work time and decrease the economic burden on the patient and the family. Fewer visits to the doctor would ease the burden on tottering health systems, and funds could be redirected to basic health care and TB control programmes.

Simpler diagnostic and treatment tools will result in savings and make the healthcare systems more efficient. Dr Mel Spigelman, MD, CEO of the TB Alliance stressed upon the importance of improving the quality of health care systems. He said that tuberculosis is indeed a disease of the poor. He agreed that some life style changes may trigger off the disease. Yet most of it occurs in non smokers and non diabetics. He said that there was evidence that every time after an economic downturn, TB incidence worsens.

The side effects of TB medicines are devastating, more so in the case of MDR TB, or in those suffering from TB and HIV. Poverty results in severe malnutrition, as patients cannot afford a proper, nutritious diet. This further increases the chances of co infection. A healthy diet and properly ventilated living spaces are very important in management of the disease.

Barriers to adherence of the drug regimen are socioeconomic. Francis George Apina, a TB/HIV Advocacy Manager and a patient representative from Kenya, voiced the sentiments of many when he lamented that "TB deprives families/communities, resulting in increased poverty and a sense of hopelessness. The long length of treatment, the severe side effects, and the far away location of the nearest health centre very often result in the patient discontinuing treatment and becoming more prone to MDR/XDR TB which is more costly to treat. An over burdened health system cannot deal with these socio economic problems. So the patients are sent back home—to infect more people in the process."


Francis pleaded for the need of new TB drugs, which can rapidly kill the TB bacilli with fewer side effects and which are also compatible with ARVs. He appealed to the fund managers, researchers, drug manufacturers and regulators to help speed up this process

There is an urgent need for more robust drugs to address the challenges and unmet needs in TB therapy. According to Dr Brian Woodfall, head of the Medical Department at Tibotec, successful drug development is not achieved till new cures reach the affected communities. Such a drug should comply with the four As--- Affordability, Adoption, Availability, and Appropriate use.

So, in the words of Francis Apina, "We need a game changer in new TB drugs development like never before. For people living with HIV and their families, the search for new TB drugs - especially those that can be taken with anti retroviral drugs—is a race against time."

Thus future regimens for TB treatment should be more patient friendly, by being cheaper, safer and by drastically reducing treatment time. A faster and simpler cure for TB will save lives and have tremendous global benefits. It would improve treatment compliance (thus preventing the emergence of the deadlier drug resistant strains) and allow more patients to be treated.
This is exactly what organizations like the TB Alliance and its partners are striving for. Thanks to the untiring efforts of several agencies, today the global portfolio includes 9 new TB drugs in clinical stages of development, three of which are part of the TB Alliance's portfolio.

There are still miles to go before we can rest and sleep. But well begun is half done. The time has come for novel TB regimens to be realistically conceived and accomplished. We all hope that CPTR will make a positive difference in the lives of millions of TB patients all over the world.

Shobha Shukla - CNS(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. She is supported by Global Alliance for TB Drug Development (TB Alliance), the Bill & Melinda Gates Foundation, the Stop TB Partnership Working Group on New Drugs, Treatment Action Group (TAG) and CNS to write from Addis Ababa, Ethiopia from the Open Forum-4.Email: shobha@citizen-news.org, website: www.citizen-news.org) 

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Regulatory Conference Shows The Way Forward From Lessons Learnt In The Past

The 4th Open Forum Conference was held in Addis Ababa, Ethiopia on 18th and 19th August to address key issues in developing new drugs for tuberculosis, which kills nearly 2 million people every year and is becoming increasingly resistant to the current drugs. The conference, with a special focus on Africa, brought together regulators, scientists and other interested stakeholders, from all around the world, to share knowledge and build a proper infrastructure needed to adopt new and improved TB treatments. They deliberated over an innovative drug development model which will reduce the usual time taken to develop safer and more effective TB drug regimens by almost 75%. Read more




New drugs development for TB treatment seemed to have been stalled until a decade ago, with no new treatments in the pipeline. But thanks to the initiatives taken by the Global Alliance for TB and due to investments in TB research by global funders, there are, at present, 10 new compounds in the pipeline, three of which are in clinical trial stages.

Mel Spigelman, MD and CEO of the TB Alliance agreed that "Today there is unprecedented hope for better treatments for tuberculosis. Now that there are promising compounds in the global pipeline, it is important to speed them through clinical development so they can reach the millions in need."

Since the 1950s, researchers have known that in TB treatment (or for that matter, treatment of other diseases as well), mono therapy is dangerous as it creates drug resistance. So, to be effective, it must be delivered in multidrug regimens. Moreover, the current TB therapies are long and complicated, and also incompatible with commonly used HIV infection. The current treatment, for drug sensitive active disease, uses 4 drugs which need to be administered daily for at least 6 months. Treatment for multidrug resistant TB (MDR) is still longer and requires more expensive and toxic drugs.

Under the traditional paradigm, TB drugs were developed and registered separately, and substituted/added one at a time, into existing combination therapies. For each substitution, the drug had to be tested in clinical trials, which normally takes 6 years. So, a novel four drug therapy would have required a minimum of 24 years, before it could benefit those who needed it urgently.

The new TB drug development model focuses on testing novel combination-drugs together in the development stage, rather than individual drugs. This would drastically reduce the development time for building new regimens.

"This collaboration harnesses innovation to speed availability of a shorter and more effective treatment for TB," says Margareth Ndomondo Sigonda, pharmaceutical coordinator of the New Partnership for Africa’s Development. "It is important for global regulators to harmonize regulatory guidance and provide efficient regulatory processes for new TB regimens to speed adoption and make an impact."

The Minister of Health of Ethiopia rightly believes that, "New technology and innovation are necessary to defeat tuberculosis. This event is important because Africa's regulators, systems, and, above all else, people, must be prepared to fully maximize the promising innovations coming through the pipeline."

This innovative model is part of a wider programme called the ‘Critical Path To TB Drug Regimens (CPTR)’ which was launched by FDA Commissioner Margaret Hamburg on March 17, 2010, and is led by the Bill and Melinda Gates Foundation, the TB Alliance, and the Critical Path Institute. It aims to reduce the broad obstacles facing TB drug development.

The take home messages after two days of intensive deliberations, reiterated that the diagnosis, treatment and care of tuberculosis continues to be immensely challenging, not only in the context of Africa, but other countries too, having a high burden of the disease. On the one hand, inadequate resources are impeding development/testing of new drugs while on the other hand, weak health systems are constraining time bound deliverables to the affected community. However, in this dismal scenario, there have been a few success stories too (in Lesotho, Georgia and Ethiopia). As Dr Spigelman rightly said, "Big progress comes from small numbers."

According to him, the way forward has three major components:
(i) A strong political will, which is committed to take care of public health. Without this key element the fruits of labour of developers of new drug regimens will not be able to reach the affected community.
(i) Innovations, to optimize the use of the limited resources available. An innovative approach to make the system work more efficiently will result in ‘doing more with less’.
(ii) Linkage, of all the individual areas of expertise of experts from diverse fields. Researchers, pharmaceutical developers, regulatory agencies and civil society organizations - all need to work not only in their individual capacities, but also together. Everyone needs to be informed about what everyone else is doing.

Only then will it be possible to overcome obstacles and speed up the urgently required new TB regimens to reach the people who need them most.

Together we shall overcome one day, which is not far away.

Shobha Shukla - CNS(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. She is supported by Global Alliance for TB Drug Development (TB Alliance), the Bill & Melinda Gates Foundation, the Stop TB Partnership Working Group on New Drugs, Treatment Action Group (TAG) and CNS to write from Addis Ababa, Ethiopia from the Open Forum-4.Email: shobha@citizen-news.org, website: www.citizen-news.org)

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