United National Interactive Preparatory Hearing on Tuberculosis

Statement by Matthew M. Kavanagh, PhD
Director, Global Health Policy & Governance Initiative, O’Neill Institute for National & Global Health Law at Georgetown University
Matthew.Kavanagh@georgetown.edu

We start off by echoing the call by the Executive Director of Stop TB for bold action and political leadership. We emphasize the political part.

Member states have committed to a variety of human rights instruments that create legally binding obligations on the Human Right to Health

This includes access today to medicines that are Available, Accessible, Acceptable and of high Quality (AAAQ).

I want to be very clear: right now the zero draft political declaration fails to fully address this right.

I also want to echo Dr. Madhukar Pai’s core point—we have to use the tools we have right now.

Today treatment for MDR-TB can last two years. Months of painful daily injections and nearly 15,000 pills. Cure rates are horrific—only half of people will be cured.

Meanwhile people pay a horrible price—many go deaf, have serious lung damage.

As we heard in a powerful example from Kenya earlier, catastrophic healthcare costs mean families choose between eating and paying for TB treatment.

The conversation on R&D for new drugs is critical.

BUT people have a human right today to the highest attainable standard of health, which is not being realized with existing drugs. This does not mean the highest standard drug companies based in wealthy countries will agree to.

Ensuring that right is a core duty of member states. It is NOT a distraction as was stated earlier. In fact, focusing only on R&D ensures people only with wealth and in wealthy nations will have access.

Despite the existence of better medicines like Delamanid or Bedaquiline today only about 12% of those in need have received access. Initial data from 9 countries from the endTB project presented in October showed very high culture conversion rates of 82%, in a median of less than 2 months.

We echo the call to hold governments accountable for introducing new drugs. And no, price is not the only problem.
But it is one problem—the cost of new drugs can double the cost of current MDR-TB treatment.

Donations are not the answer—which is why the WHO recommends against them. We know from HIV that these programs are temporary, come with strings in the long term, and do not address the obligations of states to take action for their people.

If we have learned anything from HIV it is that low-cost generic competition is what will revolutionize access to drugs. Not donations. Not governments over-paying.

Member states have already agreed. Not just at the WTO in the Doha Declaration, but in the UN High Level Meeting on HIV in 2011 and again in 2016; at the HLM on Non- Communicable Diseases in 2011; and just a few weeks ago in decision A71/12 at the World Health Assembly.

Here are a few lines from the last Political Declaration on HIV: Member states agreed to:

60 (l). Commit to urgently removing obstacles that limit the capacity of low- and middle-income countries to provide affordable and effective prevention and treatment products …. including by amending national laws and regulations…

(i) The use, to the full, of existing flexibilities under the Agreement on Trade- Related Aspects of Intellectual Property Rights specifically geared to promoting access to and trade in medicines….

(ii) Addressing barriers, regulations, policies and practices that prevent … generic competition in order to help to reduce costs
and… apply measures and procedures for enforcing intellectual property rights in such a manner as to avoid creating barriers to the legitimate trade in medicines, and to provide for safeguards against the abuse of such measures and procedures;

These have already been agreed to by Member States. These commitments must be made on TB as well.

I understand, however, that some Member States wish to avoid discussion of access to medicines in the declaration. This sends us back to 2001.

Most importantly, it would be a dereliction of basic state duties and obligations enshrined in international human rights law.

We do not have to wait to see if there is a problem. We have seen what happens in HIV and now we are seeing it in TB.

Millions die waiting for a solution.

We have learned this lesson over and over.

If states do not commit to bold action today, making use of all their legal rights, the vision of a TB-Free future is a mirage.