News India Times – that’s all you need to know Opinion News India Times May 26, 2023 4 Disclaimer:The views and opinions expressed on this page are those of the authors and Parikh Worldwide Media does not officially endorse, and is not responsible or liable for them. Vaccine Hesitancy Is Growing. DoctorsWill Have To Fight Back Why Is Tuberculosis, A Curable Disease, Still Allowed To Kill Millions? I n 2019, I visited Sierra Leone’s Lakka Government Hospital, a tuberculosis treatment center. At the time, I knew almost nothing about TB. I didn’t know that it is curable, or that for almost all of human history, it has been the world’s deadliest infectious disease. And I certainly didn’t know that about 1.5 million people still die each year of tuberculosis - more than die of malaria, homicide and war combined. That fact is especially hor- rifying given that TB has been largely curable for over 70 years. I really visited the hospital only as a favor to a Sierra Leonean physician, Mohamed Bailor Barrie, with whom I was working on a different project related to maternal health. When we arrived at the hospital, a young boy - he looked perhaps 9 or 10 - bounded toward our car and in- troduced himself as Henry. He immediately set off to give me a tour of the hospital, tugging my shirt this way and that to show me the patient wards, the treatment rooms and a laboratory that could quickly diagnose tuberculo- sis. It took me quite a while to realize that Henry was not an official Lakka Government Hospital tour guide; he was a patient. He was not 9 years old but 16, and looked young only because his body had been so profoundly emaciated by TB. And although he was ambulatory and able to show me the entire hospital, he would soon be critically ill. I later learned that Henry had multidrug-resistant tuberculosis, also known as MDR-TB, an infection that does not respond to the standard first line of antibiotic treatment. Soon after I met him, Henry required blood transfusions because he lost so much blood from lung hemorrhaging. The TB invaded his lymph nodes, causing swelling in his neck that eventually ruptured into an open wound. He was, by all accounts, dying. Curing any form of TB requires a cocktail of antibacte- rial drugs, generally given daily for several months, but MDR-TB is even harder to treat. The Centers for Disease Control and Prevention estimates that half a million people around the world develop MDR-TB annually, and about 200,000 die. If these strains are not controlled by 2050, according to the CDC, MDR-TB could kill more than 2.6 million annually. Henry was fortunate in one sense: Unlike many MDR- TB patients, he had access to medication, thanks to a partnership between the nonprofit Partners in Health and Sierra Leone’s Health Ministry. But even the second- line treatment also failed him. From the 1940s to 1960s, eight separate classes of anti- TB drugs were synthesized to fight the disease. But then no new drugs were developed to fight TB until 2012. As tuberculosis became less of a problem in rich countries with robust health-care systems, the profit incentives changed, making TB less of a priority for pharmaceutical companies even as it continued to be a huge problem for humanity. As journalist Tina Rosenberg once noted about another infectious disease, “Probably the worst thing that ever happened to malaria in poor countries was its eradication in rich ones.” In 2012, a new drug appeared at last: bedaquiline, which has become a critical component in MDR-TB treatment cocktails. Most of the research dollars that went into the development of bedaquiline came from the public in many countries - taxpayers invested far more in bedaquiline research and trials than pharmaceutical cor- porations did - and yet the drug is owned and distributed entirely by a private corporation, Johnson & Johnson. Its patent expires just two months from now, but the company is attempting to “evergreen” its monopoly by slightly adjusting the drug’s formulation, enabling John- son & Johnson to enforce secondary patents and extend its control of bedaquiline in most countries with a high TB burden. This would be good news for Johnson & John- son, I suppose, but bad news for almost everyone else on the planet. It would mean fewer people with access to MDR-TB treatment, which over time would mean more private and public health costs fromTB, easier spread of MDR-TB, more suffering and far more death. Johnson & Johnson currently prices bedaquiline at $1.50 per day (or $272 over the six-month treatment regimen). DoctorsWithout Borders has argued that “with scale-up and generic competition, the price of beda- quiline would be expected to drop, bringing it closer to its target price of $0.50 per day,” a price at which beda- quiline would still be profitable for manufacturers. This almost 67 percent reduction in price would dramatically increase the availability of bedaquiline. By mid-2021, Henry had been a patient at the Lakka hospital for over two years, and he was still sick. His parents, seeing him decline in their weekly visits, begged to take him home so they could be with their son in his final days. But just then, Henry became the very first Sierra Leonean patient to receive a newly designed treatment regimen that included bedaquiline. This new treatment is quicker, less toxic and more effective - and it saved Henry’s life. After more than 1,000 days of constant hospitalization and intensive treatment, Henry was at last cured. When I visited him recently, he was a healthy 20-year-old living with his family in Freetown. “I am so happy to be home again,” he told me. Henry is attending university now, studying human resource management. This year, hundreds of thousands of people who should survive TB will instead die because they cannot afford or don’t have access to the best and newest treat- ments. The end of the bedaquiline patent would result in many of those lives being saved. In March, regulators in India rejected Johnson & Johnson’s attempt to extend its patent, opening the way for production of generic beda- quiline there, but it can be difficult for poorer nations to challenge big pharmaceutical companies. I’m glad Johnson & Johnson has profited frommanu- facturing and selling bedaquiline. Pharmaceutical com- panies need to see the value of investing in new tubercu- losis treatments. But a decade after the drug’s emergence, it is high time for the company to relinquish its extended patent claims. Governments primarily funded bedaqui- line’s development, and we can pressure our govern- ments to make the drug widely and affordably available. This means telling elected representatives that the use of secondary patents in deeply impoverished communi- ties is unconscionable; it means supporting organiza- tions fighting for expanded TB treatment access, such as DoctorsWithout Borders and Partners in Health; and it means urging Johnson & Johnson to behave responsibly. Roughly 4,000 people on this planet died of tubercu- losis yesterday. From a curable disease. We need not accept such a world. TB treatment must be made available to all, so that tuberculosis can become what it should have been long ago: history. John Green is the author of sev- eral books, including “The Fault in Our Stars” and “The Anthropocene Reviewed,” and is a longtime sup- porter of Partners in Health. -Special to TheWashington Post By John Green Photo: M easles was declared elimi- nated in the United States in 2000, and the credit goes to parents who, year after year, brought their children to get measles, mumps and rubella vaccinations. When enough children are vaccinated, say 90 percent or more in a school or com- munity, they reach herd immunity, and the highly contagious measles virus has nowhere to go. Now, a new public opinion survey of attitudes toward childhood vac- cines suggests most parents will continue this essential practice - but there is reason to worry about growing skepticism of lifesaving medications. The survey by the Pew Research Center of 10,701 U.S. adults conducted between March 13 to 19, published Tuesday, found that Americans “remain steadfast in their belief in the overall value of childhood vaccines,” with no change over four years “in the large majority who say the benefits of childhood vaccines for measles, mumps and rubella (MMR) outweigh the risks.” This view was endorsed by 88 percent of those questioned, compared with just 10 percent who said the risks outweigh the benefits, a share unchanged from before the pandemic. Uptake of the vaccine na- tionwide remains above 90 percent. Nevertheless, the report documents deepening vaccine hesitancy in the United States - that is, the tendency of people to hold back out of suspicion, disinforma- tion and anti-vaccine lobbying. This was evident in response to a question about whether healthy children should be vacci- nated as a requirement for attending pub- lic school. A surprising 28 percent of those responding said parents should be able to decide not to vaccinate their children, up 12 points from four years ago. Shifts in views among Republicans is respon- sible for this change. In 2019, 79 percent of them said they supported requiring children to be vaccinated to attend public schools; that has shrunk to 57 percent. By contrast, there is “no meaningful change” in the 85 percent of Democrats who sup- port such a requirement. Also unsettling, White evangelical Protestants backed such school requirements by 77 percent to 20 percent four years ago, but in the latest survey, the support was 58 percent to 40 percent. The survey also highlights enduring skepticism about coronavirus vaccines. Fewer than half of U.S. adults believe the preventive health benefits of coronavirus vaccines are high, while 7 in 10 hold this view of the childhood measles vaccines, the survey said. Measles spreads when an infected person coughs or sneezes. It can cause serious complications and death, espe- cially among children. A major outbreak occurred in the United States in 2019, and another last year in Columbus, Ohio, caused largely by unvaccinated children. But for the most part, outbreaks have been sporadic in the United States. The rest of the world has suffered more disease because the pandemic disrupted many childhood immunization campaigns. Even so, the United States is facing a tide of uncertainty that is unwarranted by the lifesaving performance of vaccines during the pandemic. The solution is to counter the disinformation and to realize that anti-vaccine statements on social me- dia, in particular, can be extremely harm- ful and misleading. Public health officials were slow to mount a response during the coronavirus pandemic; rapid and forceful communication should be a key public health tool and one also used on the front lines of medicine. There is high value in the message coming from family doctors. The Pew survey highlights the public’s continuing trust in information from a doctor or other health-care provider about vaccines. These clinicians can play a ma- jor role in fending off the shadowy doubts and unfounded suspicions, if they speak up forcefully, early and often. -Editorial Board, TheWashington Post