Global Financing and Long-Term Technical Assistance for Multidrug-Resistant Tuberculosis: Scaling Up Access to Treatment

Multidrug-resistant tuberculosis (MDRTB), strains of Mycobacterium tuberculosis resistant to the first-line antituberculosis drugs rifampicin and isoniazid, is a global public health concern and remains a leading cause of mortality and morbidity in lowand middle-income countries [1]. In response, World Health Organization (WHO) member states have called for action to ‘‘achieve universal access to diagnosis and treatment of multidrugresistant and extensively drug-resistant tuberculosis’’ [2]. However, the drive to eradicate MDR-TB using current strategies remains an uphill battle [3,4]. Extensively drug-resistant tuberculosis (XDRTB), a form of MDR-TB with additional resistance to the backbone of the secondline antituberculosis regimen—fluoroquinolones and injectable agents—has been officially reported in 92 countries [5]. Making MDR-TB treatment more affordable would be an important step towards improving patient access to care and reducing the significant public health burdens arising from the spread of this highly contagious airborne disease [6,7]. Here, we assess changes in MDR-TB drug prices since 2001 and identify limitations in the current system, focusing on the barriers to care delivery posed by high costs of treatment and weak health systems. Using pneumococcal vaccine as a case study to inform the fight against the global tuberculosis (TB) pandemic, we argue that a market-based strategy coupled with long-term in-country technical assistance should be utilised to scale up access to MDR-TB treatment.