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Doctors Without Borders Funds TB Research Amid Controversy on WHO Priority Pathogens List

Tuberculosis (TB) has overtaken HIV as the world’s most fatal infections, resulting in the death of more than 1.8 million people in 2016 alone, according to Medecins Sans Frontieres.

Despite these chilling numbers, the World Health Organization (WHO) left the disease off its “Priority Pathogens” list. The first-ever list was published February 27th and included “12 families of bacteria that pose the greatest threat to human health.” The decision to exclude TB from this list has generated a firestorm of controversy within the infectious disease and public health arenas.

In a statement released with the list, WHO officials noted that TB “was not included in the list because it is targeted by other, dedicated programs.” Having said that, the organization acknowledged that the infection’s “resistance to traditional treatment has been growing in recent years.”

Several organizations have responded publicly. In a Letter to the Editor of the Financial Times, for example, the Kaiser Family Foundation (KFF) wrote that WHO “has badly misstepped in leaving out Mycobacterium tuberculosis from its list of 12 priority superbugs for which new antibiotics are needed urgently… Although TB is a bacterial disease, currently available antibiotic medicines simply cannot keep up against rapidly evolving resistance… TB patients desperately need new and better medicines, and drug-resistant TB needs to be acknowledged as the biggest health threat in the antibiotic resistance crisis.”

The KFF letter goes on to describe the TB research community as “badly underfunded” and WHO’s decision as “baffling.” The group, along with several other advocacy and research organizations, including the Stop TB Partnership, the TB Alliance, and the International Union Against Tuberculosis and Lung Disease, has requested that WHO revisit the decision. However, in response to a query on the matter by Contagion®, a WHO spokesperson said that there are no plans to add TB to the “priority pathogens” list, but that the organization “plans to consult further with stakeholders and users of the [publication] on the value of evaluating other groups of pathogens for R&D prioritization using the same process.” In fact, WHO believes there is “already consensus that tuberculosis is a top priority for R&D for new antibiotics.”

The spokesperson, Olivia Lawe Davies, added, “Communication of the reason to exclude TB has clearly been inadequate... WHO has recognized TB as a global R&D priority for many years, most recently through the Global Tuberculosis Report 2016, as well as the End TB Strategy, in which intensified R&D is one of the three pillars. The purpose of the priority pathogens list was to define research and development needs for bacteria not already identified as R&D priorities, for which there are not new products in the pipeline. The bacteria included in the list cause severe and often deadly infections, are resistant to multiple antibiotics, and R&D has been very limited. The analysis carried out to develop the [list] was similar to that used for the R&D Blueprint for Action to Prevent Epidemics priority list of pathogens for which there is an urgent need for vaccines and treatments. This Blueprint list also excluded diseases that are established R&D priorities, such as pandemic influenza. The non-inclusion of TB in the [the list] does not indicate that WHO believes TB is not an R&D priority.”

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