Médecins Sans Frontiéres (MSF) on Tuesday launched a campaign to push for a US $5 price tag on a new COVID-19 rapid diagnostic test that can be used on GeneXpert, a diagnostic instrument widely deployed around the world for diagnosing tuberculosis. 

The test for SARS-CoV-2, the virus that causes COVID-19, received US Food and Drug Administration emergency use approval just last Friday, and represents a hope for scaling up COVID-19 testing in low- and middle-income countries.

The MSF announcement coincided with World Tuberculosis Day, and reflected one of the many ways in which the battle against one of the world’s oldest respiratory diseases, TB and the battle against the newest threat to lung health from COVID-19, are now converging. 

“The Xpert Xpress SARS-CoV-2 Test for testing for the novel coronavirus should be no more than $5 a cartridge,” said Sharonann Lynch, HIV and TB Policy Advisor at Médecins Sans Frontiéres/Doctors Without Borders’ Access Campaign, in an interview with Health Policy Watch. 

The US company that produces GeneXpert tests Cepheid has set the coronavirus test price at $19.80 per cartridge for 145 developing countries, according to Lynch. In high income countries, the coronavirus test will cost $35 per cartridge. 

The TB test for the platform currently costs $9.98 per cartridge for low- and middle- income countries. An HIV diagnostic test, which can also be performed on the platform, costs $14 per cartridge.

However, even the US $10 price on the TB test is too high for many countries, said Lynch. Thus, Cepheid could “drastically lower the price to $5 per test.”

An assessment of other GeneXpert tests by MSF and Cambridge Consultants found that a US $5 price tag per cartridge could still generate profit for Cepheid, as the ‘cost of goods’ – or the cost of materials, manufacturing, labour, overhead, intellectual property, and other indirect expenses – is estimated to be only  US $3. The campaign for a $US 5 coronavirus test is an extension of an existing ‘Time for 5’ campaign by MSF to knock down prices for TB and HIV test cartridges to US $5 a piece.

WHO Releases New Guidelines For Preventative TB Treatment

Also on World Tuberculosis Day, the World Health Organization released new guidelines to scale up new, and dramatically shorter preventative regimens for latent tuberculosis (TB), one of mankind’s oldest and deadliest diseases.

“COVID-19 is highlighting just how vulnerable people with lung diseases and weakened immune systems can be,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release. “Millions of people need to be able to take TB preventative treatment to stop the onset of disease, avert suffering, and save lives.”

In the context of the COVID-19 pandemic, “early evidence suggests that people with TB will be more susceptible to coronavirus and severe COVID-19,” said Lynch. 

Thus, scaling up preventative TB treatment could also help reduce negative impacts of the rapidly accelerating COVID-19 pandemic according to the WHO, which has also released guidance on how to sustain TB treatment during the COVID-19 emergency.

Tuberculosis remains the world’s top infectious killer – in 2018 there were an estimated 10 million new symptomatic infections and 1.5 million deaths.

About a quarter of the world’s population is estimated to be infected with TB bacteria, but are not sick nor contagious. However, those with such “latent” TB are at higher risk of developing active disease, which can be particularly deadly in immunocompromised people. 

Treating latent TB remains the most effective strategy to prevent the progression to active disease and protect others against onwards transmission – but has been largely neglected as a part of TB control programmes. To date, only 430,000 of the target 24 million contacts of people with active TB and only 1.8 million of the target 6 million people living with HIV have received preventative treatment.

The new WHO guidelines recommend new shorter regimens for preventative treatment for latent forms of the disease, ranging from a 1 month daily rifapentine/isoniazid treatment to 4 months of daily rifampicin alone – shaving off months from the previous standard 6-month isoniazid treatment. 

The guidelines also recommend the rapid scale-up of preventative TB treatment among populations at highest risk, including household contacts of TB patients, people living with HIV, and those with lowered immunity or living in crowded settings; integrating TB preventative treatment into case-finding efforts for active TB, and using tuberculin skin tests or an interferon-gamma release assay (IGRA) to test for infection when tests are available.

Leveraging TB Knowledge To Fight COVID-19

As the COVID-19 pandemic accelerates, the World Health Organization and leading TB organizations also are promoting a joint approach to tackling both the world’s oldest and newest respiratory threats. 

New WHO guidance for TB programme directors recommends leveraging TB prevention strategies, technologies and logistics, and programmatic staff to tackle the diseases. 

TB staff, with years of experience in low-resource settings, are well positioned to offer technical assistance in contact tracing and active case finding, the cornerstones of a robust COVID-19 response. 

“We know what works to fight COVID-19 from our experience and the tools we have developed to end TB: infection control, wide-spread testing, contact tracing, X-rays, artificial intelligence, telemedicine and psycho-social support,” said José Luis Castro, executive director of The International Union Against TB and Lung Diseases (The Union) in a press release.

However, some TB advocates have also expressed concerns that the global focus on COVID-19 could shift resources from essential TB treatment services. 

“The COVID emergency should marshall all necessary resources, but not at the expense of TB services, including TB testing, or people with TB,” said Lynch.

Additionally, with countries enacting more strict travel restrictions in the face of accelerating COVID-19 outbreaks, it may be time to try a new model of care for TB patients

For those with active TB, a full treatment course is at least 6 months and treatment is usually directly observed by providers, which means patients or healthcare workers must travel daily to meet in clinics or homes to administer treatment. 

“To reduce the risk for existing patients, [we] must seek ways to re-design models of care to provide treatment for people with TB in the community and use remote telemedicine and web apps to support them,” Lynch suggested.

Image Credits: WHO/UNITAID, CNS Images.