Childhood TB will no longer be 'the neglected of the neglected': Spigelman

Bobby Ramakant - CNS
"2013 has been a year of tremendous progress. I am optimistic that paediatric TB will no longer be 'the neglected of the neglected'. With help of UNITAID and US Agency for International Development (USAID) we are embarking on significant changes in this direction” said Dr Melvin Spigelman, President and CEO of Global Alliance of TB Drug Development (TB Alliance). He was addressing the TB Alliance Stakeholders’ Association Annual meeting before the 44th Union World Conference on Lung Health opens in Paris later this week.

Dr Cherise Scott from TB Alliance who was moderating a panel on Paediatric TB drugs said that there are no safe and appropriately dosed formulations of first-line drugs for children. TB is one of the top ten causes of death among children. In 2012, an estimated 530,000 to a million children acquired TB. Every day over 200 children under the age of 15 die worldwide from TB, bringing the annual death toll to 74,000 in case of HIV-uninfected children. However the actual burden of childhood TB could be much higher because TB in children often goes undiagnosed. Dr Scott added that her team’s goal is to increase access to optimal paediatric TB medicines which means correctly doses, properly formulated, affordable, and high quality products should be available to all children who need them.

UNITAID has been committed to advance the cause of childhood TB since its inception in 2006 among other major contributions it has made to global health. Janet Ginnard from UNITAID identified some of the market challenges related to paediatric TB drugs. She listed poorly adapted products (those products that are available and not well adapted for paediatric use), unknown scale of the problem, already small market reduced further, limited market incentives, and high risk to participate in market, as some of the key challenges from a perspective of a market investor or manufacturer.

Janet Ginnard said that the estimated incidences of childhood TB (530,000 to a million cases) are based upon adult incidence of TB. We clearly need to get more accurate estimation done of childhood TB in the community. Gaps in information exist at many levels, including incidence and treatment rates, which obscure the true size of the market. The lack of information acts as a disincentive to manufacturers.

Ginnard further added that childhood TB data was first reported by countries in 2012 according to which 349,000 children were diagnosed and notified with TB. Out of these 242,000 received quality-assured standard treatment from the Global Drug Facility (GDF, 2010 data) – which is only 20-25% of the total number of children who might be in need of TB care every year. There is no data reported by countries to the WHO on children who have completed treatment and got cured of TB.

Grania Brigden from MSF Access Campaign spoke on policy and uptake challenges related to paediatric TB drugs. “If a country has not adopted the new guidelines then it is very difficult to implement separate treatment guidelines. Stock-outs of TB drugs at the peripheral health structures due to disruption in funding are a major issue too” said Brigden. She underlined the difficulty in prescribing current anti-TB drug formulations to match new dosages.

She shared that 34 countries that participated in a survey, 29 had childhood TB guidelines in place. 19 countries had incorporated the new 2010 guidance in national guidelines on childhood TB and 16 countries had started to implement the new dosages. To deliver correct anti-TB drug dosages to children, 11 countries were using adult formulations and breaking or crushing them to give appropriate dosages to children as per the guidelines. 11 countries were combining existing Fixed Dose Combinations (FDCs) and loose products while 2 countries were using only loose products.

"If we can shift TB diagnosis and treatment out of specialized programmes and into other existing maternal and child health activities, we automatically gain reach and scale. Combining that scale with investment in tools and medicine would save tens of thousands of lives," said José Luis Castro, Interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) to Citizen News Service (CNS).

Brigden added that they are considering partnering with nutrition projects or maternal and child health projects to improve responses to childhood TB. Just earlier this month, a "Roadmap for Childhood Tuberculosis: Towards Zero Deaths" - the first ever plan which specifically addresses TB in children and outlines the path towards zero deaths from childhood TB - was jointly launched, by The Union, WHO, Stop TB Partnership and other partners.

The roadmap estimated that these lives could be saved by spending US$120 million a year, which includes US$ 40 million for antiretroviral therapy and preventive therapy for children co-infected with TB and HIV. This is a small price tag for a global disease and is needed to improve detection, develop better medicines for children and integrate TB treatment into existing maternal and child health programmes among acting upon other action points the roadmap chalked out.

Bobby Ramakant, Citizen News Service (CNS)
October 2013
The author is supported by the Global Alliance for TB Drug Development (TB Alliance) to provide conference coverage from the 44th Union World Conference on Lung Health in Paris, France: 30th October – 3rd November 2013

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