Excerpt

To effectively treat patients diagnosed with drug-resistant (DR) tuberculosis (TB) and protect the population from further transmission of this infectious disease, an uninterrupted supply of quality-assured (QA), second-line anti-TB drugs (SLDs) is necessary. Patients diagnosed with multidrug-resistant tuberculosis (MDR TB)—a disease caused by strains of Mycobacterium tuberculosis (M.tb.) resistant to two primary TB drugs (isoniazid and rifampicin)—face lengthy treatment regimens of 2 years or more with daily, directly observed treatment (DOT) with SLDs that are less potent, more toxic, and more expensive than those used to treat drug-susceptible TB. From 2000 to 2009, only 0.2–0.5 percent of the estimated 5 million MDR TB cases globally were treated with drugs of known quality and in programs capable of delivering appropriate care (Keshavjee, 2012). The vast majority of MDR TB patients either died from lack of treatment or contributed to the spread of MDR TB in their communities. A strengthened global supply chain for SLDs could save lives by consistently delivering high-quality medicines to more of the people who need them.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE FOR THE WORKSHOP ON GLOBAL DRUG SUPPLY CHAIN FOR SECOND-LINE ANTI-TUBERCULOSIS DRUGS
• FORUM ON DRUG DISCOVERY, DEVELOPMENT, AND TRANSLATION
• Reviewers
• Acronyms
• 1. Introduction
  • BACKGROUND AND HISTORY OF THE CURRENT GLC MECHANISM
  • PRINCIPLES OF DRUG SUPPLY CHAINS
  • BARRIERS, CHALLENGES, AND NEEDS
• 2. Logistics, Supply, and Demand
  • QUALITY ASSURANCE
  • FORECASTING AND INFORMATION MANAGEMENT
  • DRUG SHORTAGES
• 3. Financing of MDR TB SLDs
  • FUNDING OF THE MDR TB SUPPLY CHAIN
  • MODELS FOR FINANCING AND SUPPLY
• 4. Innovative Suggestions and Potential Solutions
  • MECHANISMS OF PURCHASE AND SUPPLY
  • LOGISTICS, SUPPLY, AND DEMAND
  • INNOVATIVE FINANCING
  • REFLECTING ON THE WAY FORWARD
• References
• APPENDIXES
  • Appendix A Workshop Agenda
  • Appendix B Participant Biographies
  • Appendix C Registered Workshop Attendees

Rapporteurs: Anna Nicholson, Rebecca A. English, Rita S. Guenther, Anne B. Claiborne

This activity was supported by contracts between the National Academy of Sciences and Department of Health and Human Services (Contract Nos. N01-OD-4-2139 and HHSF223001003T), Abbott Pharmaceuticals, American Diabetes Association, American Society for Microbiology, Amgen Inc., Association of American Medical Colleges, Bristol-Myers Squibb, Burroughs Wellcome Fund, Celtic Therapeutics, LLLP, Critical Path Institute, Doris Duke Charitable Foundation, Eli Lilly and Company, Eli Lilly & Co. Foundation, FasterCures, Foundation for the NIH, Friends of Cancer Research, GlaxoSmithKline, Janssen Research & Development, LLC, March of Dimes Foundation, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, and Pfizer Inc.

Suggested citation:

IOM (Institute of Medicine). 2013. Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis: Workshop Summary. Washington, DC: The National Academies Press.

The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.