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Originally published in Science Express on 19 July 2001
Science 10 August 2001:
Vol. 293. no. 5532, pp. 1049 - 1051
DOI: 10.1126/science.1061861
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Policy Forum

PUBLIC HEALTH:
Responding to Market Failures in Tuberculosis Control

Rajesh Gupta,* Jim Y. Kim, Marcos A. Espinal, Jean-Michel Caudron, Bernard Pecoul, Paul E. Farmer, Mario C. Raviglione

The specter of multidrug-resistant tuberculosis (MDR-TB) threatens the gains achieved by tuberculosis control through international recommendations currently accepted by 127 countries. The high cost of second-line drugs is a clear example of a market failure serving as a barrier to treatment of MDR-TB cases. Gupta et al. describe an approach based on policy development, consolidating and increasing demand, and increasing supply to decrease the cost of second-line drugs. As a result, prices decreased from 48-97% for a treatment regimen and competition was increased in monopoly markets. An independent scientific committee fosters access to the drugs under tightly monitored pilot projects to prevent the creation of resistance to second-line drugs. This strategy may be applicable to other infectious-disease treatment efforts.

R. Gupta, M. A. Espinal, and M. C. Raviglione are with the Stop TB Department, Communicable Diseases, World Health Organization (WHO), 20 Avenue Appia, Geneva, Switzerland. R. Gupta, J. Y. Kim, and P. E. Farmer are in the Program in Infectious Diseases and Social Change, Harvard Medical School, Boston, MA 02115, USA. J.-M. Caudron is with Médecins Sans Frontières (MSF), Artsen Zonder Grenzen-Rue Dupréstraat, 94 1090 Brussels, Belgium. B. Pecoul is with Access to Essential Medicines, MSF, Case Postale 6090, CH1211 Geneva 6, Switzerland.

*To whom correspondence should be addressed. E-mail: guptara{at}who.int

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Science. ISSN 0036-8075 (print), 1095-9203 (online)