Great essay—thanks for writing. I think one interesting element to explore is the race against drug resistant TB, and how that could set back progress/increase costs in a way that narrow cost-effectiveness analysis can’t really show.
When thinking about funding—I think it’s clearer to see how philanthropy can/should support in low income settings. I’m not convinced that charitable money should be needed to set up new manufacturing in Europe, especially if that’s likely to happen anyway.
Thanks for your comment. Just a sidenote to your point: I think it’s a curious element of TB history that we’ve known about the dangers of drug-resistant strains since at least the 1950s, not just as a potential future threat but right away in real world practice; the reason streptomycin is combined with other powerful antibiotics (e.g. isoniazid and others) as part of standard TB treatment is because that’s the only way to completely clear all bacilli. I wrote a bit about this in my piece for Metaculus: https://www.metaculus.com/notebooks/12130/from-reduction-to-elimination-replicating-the-successes-of-historical-tuberculosis-control/
I agree, I would also choose other interventions over manufacture of rifapentine in Europe, though I am not sure it’s likely to happen without incentives for Sanofi. As helpful as it might be in countries like Moldova, Estonia, etc., I think the preceding cause areas would have a far greater impact (they’re listed in order of my best guess at their value).
I added this mainly because I wanted to include a variety of options. Open Philanthropy may opt for a less effective but more tractable option, for example. It also shows just how many possible avenues there are to contribute to TB efforts.
Great essay—thanks for writing. I think one interesting element to explore is the race against drug resistant TB, and how that could set back progress/increase costs in a way that narrow cost-effectiveness analysis can’t really show.
When thinking about funding—I think it’s clearer to see how philanthropy can/should support in low income settings. I’m not convinced that charitable money should be needed to set up new manufacturing in Europe, especially if that’s likely to happen anyway.
Thanks for your comment. Just a sidenote to your point: I think it’s a curious element of TB history that we’ve known about the dangers of drug-resistant strains since at least the 1950s, not just as a potential future threat but right away in real world practice; the reason streptomycin is combined with other powerful antibiotics (e.g. isoniazid and others) as part of standard TB treatment is because that’s the only way to completely clear all bacilli. I wrote a bit about this in my piece for Metaculus: https://www.metaculus.com/notebooks/12130/from-reduction-to-elimination-replicating-the-successes-of-historical-tuberculosis-control/
I haven’t looked into projections of MDR-TB specifically, but this would definitely be a worthwhile line of inquiry. Interestingly, a quick search shows some advocacy for combined TB and AMR control efforts in LMICs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840628/
https://lshtm.ac.uk/newsevents/news/2020/where-and-how-does-tb-fit-amr-agenda
I agree, I would also choose other interventions over manufacture of rifapentine in Europe, though I am not sure it’s likely to happen without incentives for Sanofi. As helpful as it might be in countries like Moldova, Estonia, etc., I think the preceding cause areas would have a far greater impact (they’re listed in order of my best guess at their value).
I added this mainly because I wanted to include a variety of options. Open Philanthropy may opt for a less effective but more tractable option, for example. It also shows just how many possible avenues there are to contribute to TB efforts.