Abstract
South Africa’s expenditure on tuberculosis (TB) research and development (R&D) is insignificant relative to both its disease burden and the expenditure of some comparator countries with a minimal TB incidence. In 2010, the country had the second highest TB incidence rate in the world (796 per 100,000 population), and the third highest number of new TB cases (490,000 or 6% of the global total). Although it has a large TB treatment program (about $588 million per year), TB R&D funding is small both in absolute terms and relative to its total R&D expenditure. Given the risk and the high cost associated with drug discovery R&D, such neglect may make strategic sense. However in this analysis it is shown that TB R&D presents a unique opportunity to the national treasuries of all high-burden countries. Using two separate estimation methods (global justice and return on investment), it is concluded that most countries, including South Africa, are under-investing in TB R&D. Specific investment targets for a range of countries, particularly in areas of applied research, are developed. This work supports the outcome of the World Health Organization’s Consultative Expert Working Group on Research and Development: Financing and Coordination, which has called for “a process leading to the negotiation of a binding agreement on R&D relevant to the health needs of developing countries”.
Highlights
Tuberculosis (TB) is a bacterial disease that is caused by pathogenic bacteria Mycobacterium tuberculosis (Mtb)
In response to this situation, the South African National Department of Health has adopted the Negotiated Service Delivery Agreement (NSDA) [6], which contains a number of TB-specific objectives including a decrease in the burden of disease from Mtb, an increase in the TB cure rate from 64% to 85%, and an increase in the TB treatment completion rate
The present TB expenditure of both the United States and the United Kingdom are already close to the recommended levels (90% and 94% of the calculated targets, respectively); China, South Africa and Japan are below 1% of the target, and considerable increases in their respective TB research and development (R&D) budgets are both required and justifiable
Summary
Tuberculosis (TB) is a bacterial disease that is caused by pathogenic bacteria Mycobacterium tuberculosis (Mtb). Expected that the development of new TB therapies in high incidence countries, as a means of reducing costs in the longer term, would be highly attractive The reasons for this ongoing neglect of health research remain obscure unless one accepts the argument that national treasuries as a general rule shun health research on the basis that such investments carry high risk with limited hope of reward. A Global Justice Index, based on GDP/capita, and a Return on Investment (RoI) Factor are developed and combined to give a target for national TB R&D expenditure for South Africa and other countries. The present TB expenditure of both the United States and the United Kingdom are already close to the recommended levels (90% and 94% of the calculated targets, respectively); China, South Africa and Japan are below 1% of the target, and considerable increases in their respective TB R&D budgets are both required and justifiable
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