In 2012, the FDA approved Bedaquiline as a drug that could treat TB. This was significant in the world of TB treatment, as the last time the FDA made such a move was 40 years prior.
New drugs hit the pharmaceutical market all the time, but they don’t always generate excitement. Usually, they do when they have the potential to change a lot of lives. For example, radical new cancer treatments. Or, drugs that could make significant progress for those trying to battle tropical diseases. Bedaquiline is one of those drugs.
As such, when Bedaquiline gained approval as a TB treatment, it caused quite a stir in many communities. TB is notoriously difficult to treat. While there are antibiotics that will tackle it on an off-license basis, their success relies on patient compliance. Also, multidrug-resistant strains are an issue. Once side-effects die down and the logistical challenges of regular hospital visits take their toll, some patients will slip off the radar.
This becomes even trickier in the developing world. In many regions, access to medical care is sparse. As a result, you can’t guarantee that TB treatment will remain accessible, even if the patient sticks to their regime. Because Bedaquiline has a long half-life and it can tackle the tougher strains of TB, it increases the chances that patients will comply and makes life easier for those living in the developing world.
More recently, Medicins Sans Frontiers have asked Johnson&Johnson to lower their Bedaquiline prices
So why are we discussing a drug that’s six years old? According to the medical outreach team Medicins Sans Frontiers, Johnson&Johnson’s pricing scheme is limiting access to those who need it most. Although prices fluctuate annually, the British Medical Journal estimates that it costs $3500 in India, where multidrug-resistant TB is prevalent.
When you look at the World Health Organization (WHO) map of TB prevalence, it’s commonest in countries where the GDP is low. Amongst the Top 10 are Nigeria, Bangladesh, and The Democratic Republic of the Congo. Again, these figures are fluctuating all the time, but here are the average GDP per capita for each of those countries:
- Nigeria: $1968.56
- Bangladesh: $1516.52
- The Democratic Republic of the Congo: $457.8
Clearly, affordability isn’t feasible for most of those who live in the countries above. Charities such as MSF try to fill the gaps. However, they are charities after all. And with a per-person treatment cost of $3500 in countries where local contributions aren’t likely, it’s easy to see why workers are frustrated with Johnson&Johnson.
How has Johnson&Johnson responded?
This isn’t the first time that MSF workers have requested lower prices for Bedaquiline. Johnson&Johnson’s response to their initial campaign was to lower the costs to $400 per round of treatment. Again, it isn’t difficult to see why this might still be too much for those who need to access the drug.
It’s also worth noting that Johnson&Johnson did receive public financing from the U.S. during the drug’s development. While TB is most common in the developing world, it can and does cross borders. In developed countries, individuals who are particularly vulnerable include those without good access to healthcare and homeless persons.
Now, MSF has called on Johnson&Johnson to make another move: open the drug up to other pharmaceutical companies, which will lower the price. As the only drug of its kind to hit the market in four decades, this doesn’t seem unreasonable. However, J&J is likely to argue that this won’t help to drive innovation.
For now, we can wait to see whether Johnson&Johnson will drop the patent. Until then, this is an area of tropical medicine where the neediest patients are priced out of care.