Mike Frick, Treatment Action Group

TB is a somewhat special case when it comes to how research is funded. For many diseases, companies invest in developing new diagnostics, medicines, or vaccines expecting that they will get a return on what they invest in research and development by selling their products after research and development ends.

At least in recent decades, companies don't have a strong track record of earning profits from the development of new TB tools. And because companies are likely to make a bigger profit developing tools for other diseases, things like cancer and heart disease, for example, there's not much investment in TB research from private sector companies, even though there's a big need for new TB tools. This situation is what we call a market failure, where there's a need, but it's not being met. And the incentives for meeting that need aren't in place for companies that we might expect would drive a lot of the research and development forward.

Because we have a market failure, TB research and development needs to get investment from other sources, principally governments and philanthropies. This market failure that characterizes TB research and development exists despite the fact that TB is a leading cause of death globally and affects millions of people each year.

The somewhat paradoxical situation arises from the fact that most people who get TB live in poverty or in low resource settings, they may be in low- or middle-income countries or upper-middle-income countries. And most tuberculosis is treated in public health systems, systems that would not be expected to pay a premium price for a new tool.

So the lack of the ability to earn a huge return on investment research and development has discouraged the pharmaceutical industry from investing in this area in earnest. And as a result, TB research depends on governments, philanthropies and multilateral organizations for the majority of its support. The biggest sources of investment in TB research are governments and private foundations or philanthropies. Governments are more likely to invest in TB research when their citizens are telling them it's important. And that's what makes advocacy for new TB tools so critical.

And it's what makes your participation in this course and your willingness to learn about TB research so that you can advocate for it such an important activity for ending this epidemic. The more advocates we have who are knowledgeable about research, how it's conducted, the resources it needs and who are able to give that message to their governments and political leaders, the faster we'll be able to end TB.

A lot of TB research is conducted by public-private partnerships called PPPs for short. Public-private partnerships play a critical role in TB research. They are funded by resources from both governments and from private sources like philanthropies, some public-private partnerships, focus on developing new medicines, while others focus on developing vaccines or new diagnostics. These public-private partnerships are effective because they can gather funding from a variety of different sources and they don't need to make a profit on selling the tools they develop.

In other words, they're an entity that is able to engage in TB research despite or because of the fact that a market failure has prevented the pharmaceutical industry from leading in this area. Some examples of PPPs that are working on developing new TB tools include FIND, which is working on developing new TB diagnostics, IAVI and TBVI, which are two PPPs working on TB vaccines, and the TB Alliance, which developed new drugs and drug regimens to treat TB.

Innovative financing mechanisms use a variety of approaches to raise funding for TB research. They bring together different sources of money. It could be government funding, private sector investment, philanthropy, but what makes them different from traditional funding mechanisms is that innovative financing mechanisms are bringing different resources together. And they're raising these resources or identifying money in new and creative ways. Innovative financing mechanisms can be an important way of raising funding for research that is sustainable over the long term.

One of the most well-known and successful examples of innovative financing for TB is Unitaid which receives some of its funding through a small tax on the sale of airplane tickets in participating countries. So every time you buy an airplane ticket in a participating airline, you are giving a small contribution to Unitaid, which then uses that money to support TB research as well as work on HIV, malaria and other priority health conditions.

According to experts in global health, financing approaches like this could potentially raise billions of dollars for TB research and do so in ways that are sustainable over the long term and automatic. Another example of innovative financing is the Stop TB Partnership's Accelerator for Impact or a4i program, which is funded by public resources with the mission of supporting the rollout of next-generation tools for TB.

One of the benefits of innovative financing is that it's a way to solve the problem of market failure. Depending on the innovative financing mechanisms used, this type of financing could allow for the cost of new medicines, diagnostics, or vaccines to be independent of or delinked from the cost of research and development. In other words, with innovative financing, we have the opportunity to ensure that new tools are affordable no matter how much it costs to develop them. And that's because with innovative financing, the money we raise for research and development, doesn't have to be earned back by charging a high price for the new tool that we're developing at the end of the day. We're essentially delinking the price of the new tool from the money we spend on developing it and in this way, we solve the market failure problem that affects TB.

Communities are also advocating for some important things to happen when research is funded by public taxpayer dollars. One thing is that research data should be freely accessible for others so that they can analyze that data and learn from them.

Another thing is that the final product or the new tool that we're working on, whether it's a new medicine or a vaccine or a diagnostic, should have an open license. This means that other manufacturers beyond just the main company developing that tool should be able to produce that product in other countries and sell it so that it can be used more widely. This creates competition, which has a favorable effect on bringing down the price of new tools and makes them more affordable and easily accessible for everybody who needs them. These steps are important for accelerating research and development and for ensuring universal access to new tools after they're developed.

If you've never heard of innovative financing before, the key takeaway for you is that these are potential sources of sustainable funding for TB research. They bring together resources from different actors and do so in ways that we work on access and innovation at the same time. As new mechanisms are proposed or developed, they may become a focal point for the advocacy that you conduct, especially if they require government support. In which case, advocacy by people affected by TB, TB survivors and those dedicated to ending TB will be crucial to raising support for innovative financing mechanisms. Your course guide has links to resources where you can learn more about innovative financing.