Drug Innovation 6: Dealing with Drug-Resistant TB

Diseases evolve. These are living micro-organisms -- bacteria, virus, etc. -- that feed on certain organs of the human body. They are part of human and natural evolution, sadly. That is why treatment and cure of old and re-emerging diseases must evolve too, endlessly. That is why drug innovation, medical science and diagnostics innovation, must continue to evolve and modernize.

Below are some stories of drug-resistant tuberculosis, as well as challenges to deal with malaria, an old disease that continues to kill hundreds of thousands of people every year until now. Estimated global death from malaria in 2010 was twice that of WHO estimates of 655,000 people. A BMGF funded study published in The Lancet showed that for the same year, estimated death from malaria was 1.24 million people, mostly children, and mostly in Africa.

1. TB drug resistance, from interaksyon.com, August 30, 2012
2. Cure for malaria, from ibtimes.co, October 25, 2012
3. Malaria deaths, from The Lancet and BBC.

http://www.interaksyon.com/article/41831/tb-drug-resistance-a-fast-growing-problem-researchers-warn

TB drug resistance a fast-growing problem, researchers warn

August 30, 2012

PARIS - Researchers on Thursday sounded the alarm over drug-resistant tuberculosis, calling it a curse that was swiftly becoming more difficult and costly to treat.

In eight countries they studied, 43.7 percent of TB patients did not respond to at least one second-line TB drug, a strategy used when the most powerful first-line drugs fail.

The probe, covering Estonia, Latvia, Peru, the Philippines, Russia, South Africa, South Korea and Thailand, is reported in The Lancet medical journal.

"Most international recommendations for TB control have been developed for MDR (multidrug-resistant) TB prevalence of up to around five percent. Yet now we face prevalence up to 10 times higher in some places," Sven Hoffner of the Swedish Institute for Communicable Disease Control wrote in a comment carried by The Lancet.

The study also found a 6.7 percent rate for an even more worrying form of resistance called XDR -- for extensively drug-resistant -- TB. It means a patient who does not respond to any two second-line drugs.

An airborne disease of the lungs, tuberculosis is usually treatable with a six-month course of antibiotics.

But if patients do not take their medicines as prescribed, the bacteria that causes TB can develop resistance to the drugs. In rare cases, people can also be infected with already resistant strains.

MDR TB in the United States can cost as much as $250,000 (200,000 euros) per patient to treat.

XDR TB requires about two years of treatment with even more expensive drugs that often cause side-effects and offer no guarantee of a cure.

According to the World Health Organization (WHO), 8.8 million people fell ill with TB in 2010 and 1.4 million died. Co-infection with the disease causes about a quarter of all deaths among people with HIV.

"So far, XDR TB has been reported in 77 countries worldwide, but exact prevalence remains unclear," study author Tracy Dalton of the US Centers for Disease Control and Prevention (CDC) said.

CSOs and State 9: The Global Fund and Corruption by Some Phil. Health NGOs

There is "The Global Fund" (TGF, http://www.theglobalfund.org/en) to fight AIDS, TB and malaria. It's a multi-billion dollars fund from different sources, public and private, I think. To be distributed to poor countries to help them fight those 3 dreaded diseases.

Last February 26, 2010, the Office of Inspector General (OIG) released its "Audit Report on Global Fund Grants to the Philippines. Long report, 121 pages, and it showed some ugly findings. That some big health NGOs in the Philippines are engaged in some financial shenanigans in handling public funds. The report can be downloaded at
http://www.theglobalfund.org/documents/oig/Philippines%20Country%20Audit%20-%20Report_26%20February%202010.pdf

On page 12, paragraph 32, the Tropical Disease Foundation (TDF), a "non-profit" group, was shown to have engaged in over-pricing, over-billing, non-documented spending, etc., it has to repay P95 million to TGF.

Here are some details:

Net amounts repayable from reconciliation of Gen Fund, P58.33 million
Overcharged laboratory test fees, P11.83 million
Excess costs charged for the NTPS, P7.47 million
Excess funds drawn for salaries, P7.40 million
Laboratory tests rates that were applied retrospectively, P4.83 million
Billing for tests that were not conducted, P4.60 million
Amounts billed to patients for tests paid from grant funds, P0.54 million

Total P95.00 million or US$ 2.021 million

The OIG summarized its finding re TDF as "TDF lacks the capacity to manage Global Fund resources. The Global Fund cannot safely invest through TDF’s current systems and processes. TDF should also refund" the above-mentioned money.

On page 57, paragraphs 225 to 229, here are some of the questionable funds involved:

a) unpaid service incentives but retained by TDF Gen. Fund account, P642,858.
b) excess service incentives with no support documents, P575,041
c) stolen staff advances, undetermined amount.

On page 58, health NGOs World Vision and the Philippine Coalition Against TB (PhilCAT) got these funds with little or zero documentation:

World Vision, Euro 16,911
PhilCAT, US$ 300,000
PhilCAT, Euro 44,691

This is how the OIG wrote,

"The PR charged unbudgeted expenses to SR program budgets. Transfers of the above funds were made to TDF’s Gen Fund account and subsequently used as part of the costs for the National Tuberculosis Prevalence Survey. In the case of World Vision, a letter was written by TDF advising that the transfers to TDF were to be charged as monitoring & evaluation costs. For Philippine Coalition against Tuberculosis (PhilCAT) there was no documentation but funds were drawn by TDF from funds held in trust on behalf of the SR. The NTPS expenditure was not budgeted to be undertaken by the SR and should not have come out of the SR budgets."

Generally speaking, a number of supposedly "non-government organizations" behave similarly, if not worse, than government officials and politicians who are corrupt. Any opportunity where they can get hold of public funds, they also steal. Or at least do not follow the agreed terms in handling and accounting properly the funds entrusted to them.

Real "non-government organizations" (NGOs) and other civil society organizations (CSOs) should not be demanding always for "more government funding" and similar demands. As the acronym explicitly says, they are "non-government" and it is not proper for them to be too cozy with, or acting like spokesmen for, government agencies and bureaucracies.

Read the OIG's audit report and be dismayed.

In the case of TDF (http://www.tdf.org.ph), they should produce a clarification paper quick. They lose their credibility from this damning report by the OIG of TGF.
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Simple Ways for Responsible Citizenry

(Note: this is my article for "People's Brigada News")

Now that the elections are over, we go back to our regular work. And while we expect our newly-elected (and re-elected) political leaders to be good and not corrupt, we citizens should do our part. Below are some simple things that we can do.

One, obey the basic laws and rules. Do not steal, do not kill, do not rape, do not extort. Traffic laws say stop on red lights, so stop on red lights. Environmental laws say do not throw your garbage just anywhere, so put your garbage only on designated places. Let us help promulgate the rule of law in our country.

Two, report directly the law violators. Or if we are afraid to directly confront those who think they are above the law, take pictures or videos, write or blog those whom we saw or observed, to be violating the laws. Like police cars or any other government vehicles, media vehicles, etc. that do not obey simple traffic rules. Let us help promulgate the rule of law in this country.

Three, take good care of our own body and that of our family members. Healthcare is first and foremost a personal and parental responsibility, not government responsibility. Do not over-drink, over-smoke, over-eat, over-fight. Preventive healthcare is several times more effective than curative. Let us have less smoking-related, less drinking-related, less fat-related, diseases and sickness. Currently, about six to seven of the Top 10 causes of death in this country are directly or indirectly related to smoking.

Four, assume more parental or guardian responsibility in our children’s education. Education is first and foremost, personal and parental responsibility, not government responsibility. Responsible parents work hard to bring their kids to good private schools. Or if they cannot afford private education, send them to public schools but provide additional learning materials like computers, books and educational tours.

Five, teach our children and minors the value of hard work and frugality. Let us inculcate self-reliance and independence, not dependence on government welfare, subsidies and dole-outs. Let us encourage them to become non-envious of the wealth and success of others if such wealth is a result of hard work and efficiency.

Six, let us support or form voluntary and civic organizations that provide charity work to our less-fortunate countrymen and fellowmen, even from other countries. The essence of civil society is the voluntary support and active involvement of citizens on issues affecting their communities with the least and minimal involvement of the government and its various agencies and bureaucracies.

Severn, let us convince, even pressure, the government and the politicians to reduce the number of taxes and fees as we are taking more personal and parental responsibilities of certain social and economic concerns that used to be heavily provided and subsidized by the government. Let us keep more of our income and savings so that we can have more resources for ourselves, our households and communities. Government should also reduce the number of regulations, restriction and other forms of prohibitions on citizen activities, especially those related to entrepreneurship and private sector job creation.

This list is not complete nor comprehensive. Readers can add their own suggestions too. What is important is that we always bear in mind the need to respect and promulgate the rule of law, where the law is above everyone, no one is exempted from the law and no one can grant exemption from the law.

If individuals, their parents or guardians exercise more responsibility of their own health, education, nutrition, housing, credit and so on, then there is no need for huge education (elementary to college), health, food, housing and related bureaucracies. And there will be no need for multiple taxes and fees to sustain huge bureaucracies and huge subsidies. And soon we will need less politicians, less government employees and bureaucrats, as more and more people will be engaged in productive work in private enterprises in a competitive business environment. Meaning more people will become self-reliant and are involved in voluntary charity work.

Let there be more entrepreneurship and private sector job creation, less public sector politicians and bureaucrats.

This way, we need not write and expect a lot from the present and future President, legislators, cabinet secretaries and other government officials. Responsible and independent citizenry is all we need to have a small, transparent, accountable and good government.

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See also:

CSOs and State 5: Subsidiarity, Decentralization and Privatization, September 04, 2008
CSOs and State 6: Stichting Kapatiran and Books for the Barrios, December 07, 2008
CSOs and State 7: Public School Library with Minimal Government, BftB, June 29, 2009
CSOs and State 8: Gawad Kalinga, Health NGOs and Taxes, September 19, 2009