By Derrick Kang
Illustration by Junyue Ma
Killing an estimated 4,300 people each day, tuberculosis continues to ravage populations around the globe. Annually, the number of deaths reaches close to 1.6 million.1 The cruel irony is that tuberculosis (TB) is curable and has been for nearly 100 years.2 Many of the people affected by TB today don’t have access to the treatments necessary to cure its infections. But to first cure TB, we need to diagnose it in patients. So how do we diagnose tuberculosis today?
One of the most common ways to test for tuberculosis is with TB skin tests. However, there are two major problems with these skin tests: time and subjectivity. TB skin tests require two separate appointments and test results must be taken manually by a medical professional. Moreover, determining the results of a TB skin test is highly subjective, risking the chance of falsely misdiagnosing a person. To avoid these issues, objective and fast tests are necessary to accurately diagnose TB.
In 2005, Cepheid, a molecular diagnostics company, launched its GeneXPert system into the clinical market.3 Since its introduction, a number of different tests have been developed to detect a variety of diseases and infections including MRSA, CML, thrombosis, etc. One of the tests developed, the XPert MTB/RIF, was an objective way to detect TB early and therefore help treat it accordingly.
There was just one problem: the price. The TB tests sold by Cepheid cost roughly $10, testing both the presence of TB and whether the particular strain of TB is resistant to a common antibiotic.4 There is also an alternative version of this test that can determine whether the strain of TB is resistant to four more different TB antibiotics and costs roughly $15.5 The $10 and $15 prices for these TB tests serve as a significant economic barrier to where TB is most common today: sub-Saharan Africa, Eastern Europe, and Asia.6 For many who live in these parts of the world, a $10 or $15 TB test is difficult, if not impossible, to afford–not to mention the already present difficulty of having a working GeneXPert machine in these places.
However, there is little to no reason to justify this $10-15 price point. In December 2019, a study conducted by Medecins Sans Frontieres (Doctors Without Borders) found that the estimated cost of making one of the TB tests was roughly $4, meaning that Cepheid charged between 250 percent and 375 percent more on these tests than it cost to produce them.7 This sparked widespread protest against these unethical pricing practices as many of the people who needed these tests could not afford them. Doctors Without Borders advocated for cheaper prices with the Time For $5 campaign that demanded a 50 percent price cut from the original $10 TB tests.
Thanks to these campaigning efforts, in September 2023, Cepheid, and its parent company Danaher, announced a 20 percent price decrease from the $9.98 TB tests to $7.97.8 While this wasn’t necessarily the 50 percent decrease in price that many campaigned for, it was still a large victory for many campaigners nonetheless. Any decrease in the price of these TB tests gives access to more and more people with methods to accurately diagnose and take necessary treatments for their health. But while this price reduction is a small victory for those living with TB bounded by economic costs, there is still a lot more to be done. For instance, the $15 TB test that can detect whether the diagnosed TB strain is resistant to more drugs did not have its price change at all.8 And since the cost of making the $15 TB test is not so different from that of the initial $10 test–now $7.97–Cepheid is still overcharging on a potentially lifesaving test. Having tests that can diagnose people objectively and accurately is certainly a great benefit, but being able to determine which treatments may be effective or not is equally if not more important and the $15 tests are a potentially great, but still expensive way of doing so.
Currently, there is still a lot that Cepheid can do to make these tests more accessible aside from price reductions, such as making their GeneXPert systems more accessible to people and medical professionals in less developed countries. But just as with the 20 percent price reduction in TB tests, further activism and campaigning for these changes are necessary in order to reduce the alarmingly high number of deaths caused by an already curable disease.
References
- USAID’s Global Tuberculosis (TB) Strategy 2023–2030 Document. U.S. Agency for International Development. Published December 8, 2022. Accessed October 12, 2023. https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/publications/usaid-glob al-tuberculosis-strategy-2023-2030#:~:text=Tuberculosis%20(TB)%20is%20one%20of.
- Jimenez D. BCG: the history and modern-day uses of the tuberculosis vaccine. Pharmaceutical Technology. Published October 4, 2021. Accessed October 12, 2023. https://www.pharmaceutical-technology.com/features/bcg-vaccine-history-modern-uses-tubercul osis/?cf-view.
- Mission & History of Delivering PCR Excellence. Cepheid. Accessed October 12, 2023. https://www.cepheid.com/en-US/about/mission-history.html.
- Xpert MTB/RIF. Cepheid. Accessed November 15, 2023. https://www.cepheid.com/en-US/tests/tb-emerging-infectious-diseases/xpert-mtb-rif.html
- Xpert MTB/XDR. Cepheid. Accessed November 15, 2023. https://www.cepheid.com/en-GB/tests/tb-emerging-infectious-diseases/xpert-mtb-xdr.html
- Tuberculosis (TB). Centers for Disease Control and Prevention. wwwnc.cdc.gov. Accessed October 12, 2023. https://wwwnc.cdc.gov/travel/diseases/tuberculosis#:~:text=TB%20occurs%20throughout%20th e%20world
- Time for $5: GeneXpert diagnostic tests. Médecins Sans Frontières Access Campaign. Published December 2, 2019. Accessed October 12, 2023. https://msfaccess.org/time-for-5-brief
- MSF: TB test price reduction is a step in the right direction. Doctors Without Borders – USA. Accessed October 12, 2023. https://www.doctorswithoutborders.org/latest/msf-tb-test-price-reduction-step-right-direction