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March 20, 2023 — On March 24, World Tuberculosis (TB) Day offers an opportunity to take stock of global progress against the deadliest disease in human history. This year, we face a sobering reality: since the start of the COVID-19 pandemic, rates of TB infection and death are higher than they’ve been since the early 2000s, setting back an already woefully inadequate effort to end the disease.
That’s why communities affected by TB around the world are backing the 1/4/6×24 Campaign, a Campaign to rally the energy, funding and political will to end TB. The 1/4/6×24 Campaign’s name comes from its central demand: the universal implementation of the shortest and best available TB regimens—one month or once-weekly for TB prevention, four months for drug-sensitive TB, and six months for drug-resistant TB—by the end of 2024. “We urgently call upon governments, global health leaders, product developers, and other duty-bearers to take actions necessary to unlock access to these shorter, safer WHO-recommended treatments for all people who need them, everywhere, as a human right,” said David Branigan of Treatment Action Group, a member of the 1/4/6×24 Campaign Coalition.
The 1/4/6 regimens represent a vast improvement upon older standards of care. The one month or once weekly regimens for TB preventive treatment (TPT) replace a six-to-nine-month regimen that often causes significant liver toxicity. The four-month treatment for drug-sensitive TB replaces a six-month course that includes drugs associated with worrisome side effects. And the six-month cure for drug-resistant TB offers a less toxic, all-oral alternative to an arduous 18-month regimen including at least six months of painful injections associated with hearing loss. “Shorter, safer regimens will transform the lives of people living with TB by making treatment easier to endure and less vulnerable to interruption. People affected by and living with TB have a right to benefit from the results of scientific progress by having access to the best available regimens for TB prevention and treatment,” said Richa Maheshwari of the Global Coalition of TB Advocates, and member of the 1/4/6×24 Campaign Coalition.
Achieving 1/4/6×24 will require more than just the regimens themselves, but also what the late Partners In Health co-founder Paul Farmer called “the five S’s” necessary to deliver effective, human-centered care: staff, stuff, space, systems, and support. “We continue to under-estimate the investments required to prevent and cure TB globally because we lack equity as a mindset. As a result, people continue to die of a completely curable disease because we are always too late,” said Maxo Luma, Executive Director of Partners In Health Liberia, a member of the 1/4/6×24 Campaign Coalition. “We have the opportunity to rectify this human rights violation by optimizing the five S’s to make these lifesaving drugs available for all those who need them regardless of geographical location, social status or any other manmade construct.”
1/4/6×24 advocates are pushing for national governments to include the shorter, safer TB regimens in national strategic plans and funding requests to the Global Fund. They are also calling on product developers to do their part to improve access. This includes tactics like calling on Johnson & Johnson to withdraw and not enforce secondary patents on bedaquiline (a core component of the 6-month regimen for drug-resistant TB) that would further delay access to affordable generics until 2027, and calling on the diagnostics company Cepheid to lower the price of GeneXpert rapid diagnostic tests for TB and improve provision of service and maintenance for testing instruments. The high prices and limited access to bedaquiline and GeneXpert stand in contrast to the massive amounts of public funding invested in their research and development.
“In demanding access to the shorter, safer regimens, the 1/4/6×24 Campaign sets an inspiring new goal to rally around to renew momentum toward ending TB. Countries faced various challenges in meeting the prevention and treatment targets set during the United Nations High Level Meeting on TB in 2018. To reclaim the urgency to end TB by 2030, the world needs need an infusion of energy, political will, and funding,” said Asgar Ismayilov of the Stop TB Partnership. In 2021, global funding for TB prevention, diagnosis, treatment, and care amounted to just $5.4 billion, about a fifth of the estimated $26.2 billion needed annually to end TB by 2030. Financial resources are badly needed to increase capacity of national TB programs to ensure that effective diagnosis and treatment with 1/4/6 regimens reach the people who need them. Achieving this will also require filling research gaps to extend the benefits of the shorter treatment and prevention regimens to all populations, including pregnant people and children. Per a recent report by Treatment Action Group and Stop TB Partnership, total annual funding for TB research and development currently amounts to just one billion dollars, less than half of what is needed to accelerate research to develop new diagnostics, medicines, and vaccines.
As we gear up for the next United Nations High-Level Meeting on TB in September, it’s time to rally all TB stakeholders around the 1/4/6×24 Campaign, to push country governments to make the ambitious commitments necessary to fund the TB response at the scale that is required, and to ensure that everyone, everywhere is able to access the benefits of scientific progress and receive the highest standard of TB prevention, diagnosis, treatment, and care.
If you are interested in interviewing members of the 1/4/6×24 Campaign Coalition, please contact firstname.lastname@example.org.
The 1/4/6×24 Campaign Coalition is an international network of TB survivors, researchers, clinicians, activists, and civil society professionals who advocate for communities affected by TB. Their institutional affiliations include:
Treatment Action Group (TAG)
Partners In Health (PIH)
Médecins Sans Frontières (MSF)
Global Coalition of TB Advocates (GCTA)
Treatment Action Campaign (TAC)
Global TB Community Advisory Board (TB CAB)
Stop TB Partnership
Survivors Against TB
The Sentinel Project Against Pediatric Drug-Resistant TB
We Are TB
TBPPM Learning Network
Asia Pacific Counsel of AIDS Service Organizations (APCASO)
African Coalition on TB (ACT)
TB Europe Coalition (TBEC)
Lean on Me Foundation
O’Neill Institute for National and Global Health Law at Georgetown University
TB Women Global
Wote Youth Development Projects
Zambia Association for Prevention of HIV and TB (ZAPHIT)