The Washington PostDemocracy Dies in Darkness

Why aren’t we producing medications for looming global disease threats?

The standard treatment for tuberculosis is 50 years old. (National Institute of Allergy and Infectious Diseases)

In the United States, any cluster of tuberculosis cases makes headlines, no matter how small the numbers. For example, local health authorities recently issued a warning to medical providers after 15 residents of a New York City neighborhood contracted tuberculosis over a two-year period — and the tabloids promptly hyped the news.

When 78 people in Los Angeles contracted tuberculosis between 2007-2013, local health authorities asked for federal help in controlling the outbreak, which then became national news.

But the reason these miniature outbreaks — and there are more than many people realize — are so dangerous is rarely addressed. The standard treatment for TB is 50 years old and we desperately need new medicines, particularly with the  global proliferation of highly drug-resistant strains of the disease. Patients today have the same chance of surviving multi-drug-resistant TB with treatment as they have of surviving the Ebola virus without any treatment.

As the home of a biomedical brain trust anchored by the National Institutes of Health and a vibrant pharmaceutical and biotech sector, the United States would seem to be the logical leader of a global push to confront TB and other infectious diseases before they become a much bigger problem. But a new report scheduled for release Thursday by the Global Health Technologies Coalition (GHTC) concludes that the U.S. needs to increase its capacity for global health research and development, especially after the recent Ebola outbreak made clear how even obscure diseases can quickly become  all-consuming problems.

The GHTC analysis reveals that over the past six years, taxpayer funding for global health research has been stagnant or declining. The drift started with the great recession of 2009 and was intensified by the sequestration of 2013, which cut government funding for global health R&D by more than 10 percent.

A key reason why the Ebola outbreak still continues in West Africa — with a death toll of more than 10,000 people — is that no one placed a high priority on Ebola drugs and vaccines. The U.S. government subsequently allocated $5.4 billion in emergency funding to contain the epidemic, a figure several times larger than what it spent in 2013 for all global health R&D. Yet TB alone kills 1.5 million people every year.

Managing health threats through emergency allocations is both ineffective and inefficient — and doesn’t provide the drugs and vaccines that can stop the next unexpected disease outbreak before it starts.

The World Health Organization predicts that over the next decade, TB alone will drain $1 to 3 trillion from the world’s poorest countries. And if drug resistance is not addressed, TB could cost the global economy $16.7 trillion by 2050 — the equivalent of the European Union’s current economic output — according to the U.K.’s All Party Parliamentary Group on Global TB.

Prior to 2009, the U.S. budgets reflected growing awareness of these problems. There was a unified bipartisan commitment to employing American-led innovation to develop lifesaving vaccines, drugs and diagnostics to address a wide range of global health challenges.

This commitment produced innovative vaccines against pneumococcal and rotavirus, preventing two of the biggest killers of children worldwide. U.S. investments contributed to the development of new vaccines against human papillomavirus (HPV), preventing the deaths of 275,000 women each year from cervical cancer. Antiretroviral therapy for HIV alone has saved 6.6 million lives since 1995. Just last week,  the U.S. Food and Drug Administration (FDA) approved a new diagnostic test for Ebola that reveals an infection in just 15 minutes from a single drop of blood.

Today, U.S.-led partnerships in health innovation are poised to deliver a treasure trove of new prevention, treatment and diagnostic tools targeting a wide range of neglected diseases. But lacking sufficient and consistent support, these tools will get stuck in the pipeline and new research initiatives will not start. And when the next Ebola-like emergency arrives--or in the case of drug-resistant TB, continues to spread--there will be widespread indignation that we failed to anticipate the threat and did not prepare accordingly.

Mel Spigelman is a physician and  president and chief executive of TB Alliance (@TBAlliance). The nonprofit organization is working on the largest number of new TB drugs in the world, and helping to introduce the first appropriate TB treatments for children.