The BRICS countries (Brazil, Russia, India, China, South Africa) accounted for around 41% of the 10 million or so cases of TB in the world in 2017. Yet, even though TB takes a tremendous human and economic toll in BRICS countries, the BRICS have up to now invested relatively little in TB research. TB research matters, since developing better tests and treatments are critical to ending TB, with mathematical models of the TB epidemic suggesting that existing tests and treatments are not good enough to bring an end to TB in the next decade or two.
Despite having 41% of the global TB burden, the BRICS contribute less than 6% of global investment in TB research. In absolute terms, India and South Africa invest most amongst the BRICS with $15 million and $6.5 million respectively in 2016. By comparison, the United States government invested around $316 million and the Bill and Melinda Gates Foundation around $120 million in the same period.
This week world leaders are gathering in New York for a United Nations (UN) High-Level Meeting (HLM) on TB. The meeting presents the biggest political moment for the global TB response in decades. The political declaration that will accompany the meeting is rightly high on rhetoric, but unfortunately low on concrete commitments.
In relation to research, for example, UN member states “commit to mobilize sufficient and sustainable financing, with the aim of increasing overall global investments to US$ 2 billion, in order to close the estimated US$ 1.3 billion gap in funding annually for tuberculosis research”. In other words, the $2 billion per year is not actually committed to. There are also no country-specific targets against which to hold specific countries accountable. The declaration rather vaguely commits to “ensuring all countries contribute appropriately to research and development”.
For all the governments of the world together to come up with an extra $1.3 billion per year should be trivial given sufficient political will. That not even this comparatively low figure could be guaranteed speaks volumes.
The HLM and its declaration is of course not the final word on TB. Things that could not be agreed through UN processes might well be agreed through smaller coalitions of willing countries. There is nothing stopping the BRICS or African Union, for example, to forge ahead with their own more ambitious set of plans and commitments. In fact, the political momentum created through the HLM makes this an opportune time to launch such more ambitious initiatives between coalitions of the willing.
In November 2017 the establishment of a BRICS TB Research Network was announced to much fan-fair at a meeting of health ministers in Moscow (a precursor meeting to the HLM). A more recent press statement explains that “the BRICS TB Research Network was established to develop robust research into new tools, diagnostics, vaccines and drugs and to inform and accelerate the best use of existing and new interventions in TB control and prevention toward elimination”.
The establishment of the network and its stated purpose is clearly a step in the right direction. Unfortunately, there is very little information about the network in the public domain. Critical questions regarding how the network will function and be funded have not yet been answered – not publicly in any case. At present it seems the network may turn out to be anything from a platform to facilitate research collaboration between countries (useful, but not a game-changing advance), to something much grander in scale whereby collaboration is supported by ambitious research and capacity-building plans backed up with financial commitments.
With sufficient funding and political will the BRICS TB research network could turn into something truly inspiring. It could help reverse the dominant dynamic of recent decades whereby the United States government and the Gates Foundation are the major funders of TB research in BRICS countries. It could change the situation whereby TB researchers in South Africa typically have to look to the United States National Institutes for Health or the Gates Foundation for grants to do research in South Africa. It can build labs, fund scholarships, an over time expand both drug-discovery and clinical trial capacity.
There is no reason why BRICS countries can’t take charge of their own medical crises –while also investing in researchers and building domestic research capacity. If built on solid principles of good, transparent and responsible science, the network could be a shining example of positive decolonisation. It can show that we can not only do world-class science here, we can fund it, direct it and drive it as well.
For the world to meet the $2 billion target requires a tripling of current funding levels – a similarly radical increase in funding will also be required to jump-start the BRICS TB research network. Of course, it will be hard to convince national treasuries to make the funds available in a time of widespread austerity. But all funding decisions are ultimately about priorities – and if TB is really a priority, as BRICS governments this week will tell us it is, then we’ll see the money on the table.