One company could charge a reasonable price, and save people from tuberculosis
Tuberculosis, the world’s deadliest infectious disease, killed 1.3 million people in 2022, according to the World Health Organization, more than covid-19 or malaria or HIV. Each week, 25,000 people die of TB, a bacterial infection that primarily attacks the lungs.
It is curable, but of the 10 million people who will become sick with tuberculosis this year, between 3 million and 4 million will go undiagnosed, often dying before they can get an accurate test.
Expensive tests
Fortunately, GeneXpert tests, made by the company Cepheid (a subsidiary of the conglomerate Danaher), can reliably determine within two hours if a patient has TB. A second cartridge can test for what is called XDR-TB, or extensively drug-resistant tuberculosis, a more complex condition that is nonetheless curable if properly diagnosed.
Testing for XDR-TB is particularly important because drug-resistant TB is a huge threat to global health. Carole D. Mitnick, a professor of global health at Harvard Medical School, told me that for every person with a drug-resistant strain that goes undiagnosed, there are as many as 30 simmering cases of XDR-TB waiting to boil over. And so these GeneXpert testing machines are critical both for saving lives now and for reducing the future burden of TB.
There’s just one problem, as a lab tech in Sierra Leone once explained to me: “The tests are great. If only we could afford them.”
But I have faith in humanity, which is why I believe the humans who work at Danaher can be persuaded to lower their margins
to increase sales and improve the overall quality of human life.
When it comes to selling their tests for tuberculosis and other infectious diseases, such as AIDS, Danaher has touted its profit strategy to shareholders: “We have a razor blade business model in mission-critical applications,” as CEO Rainer Blair put it in January.
Razor companies make a slim profit on the handle itself and then charge exorbitantly for replacement blades. That’s also the printer/ink approach. And it’s Danaher’s: Make the GeneXpert machines relatively affordable, hike the price of test cartridges.
The company knows
Last year, Danaher and its subsidiary Cepheid pledged to no longer profit in poor countries from the sale of their standard TB cartridge. That was a big step forward that will allow millions more people to access testing.
But the companies still charge almost $8 for the standard cartridge, which they say is “at cost,” but Doctors Without Borders estimates
is nearly a 40% markup. Cepheid charges almost $15 — or more than 300% more than the cost of production, Doctors Without Borders says — for every XDR-TB test cartridge.
Danaher deserves to be rewarded for developing these tests, and I’m glad they have been rewarded. But there is plenty of profit to be made in high-income countries from the company’s GeneXpert machines, testing for a variety of illnesses, including TB (which still sickens around 8,000 people per year in the United States), without sapping the very limited resources of the poorest people on Earth.
Note, too, that in developing this technology, Danaher and Cepheid received over $250 million in public funding, according to a 2021 study. Much of that support came from taxpayers like you and me. The public has the right to expect that its contributions are put to the maximum public good.
Lowering the price of these tests to $5 would save hundreds of thousands of lives over the next decade. That Danaher last year, bowing to criticism, budged on its pricing for the standard TB test was an indication it knows what the right thing to do would be.
Some polite but impassioned encouragement — from the public and perhaps from Danaher employees too — for the company to go the rest of the way might be very helpful.
My brother’s cure
Last year, my brother, Hank, was diagnosed with a cancer called Hodgkin lymphoma. Hodgkin is usually curable — with proper treatment, five-year survival rates are about 90 percent — and after four months of grueling treatment, he was declared to be in remission.
The hope and expectation is that his cancer is cured and that he will go on and live a long life. My brother and I talk every day, which means I’m reminded every day how lucky I am to speak with him, laugh with him and learn from him.
Curing his cancer reflected decades of work on discovering and improving treatments funded by both public and private investment, and curing him demanded both human expertise and technology. But, of course, it was a good investment because Hank is here with me. He will, I hope and expect, be here with us for a long time.
How can we tell people living with TB that they don’t deserve similarly conscientious care? The world’s deadliest disease is curable, and the first step toward treatment is making sure that the millions of people who would otherwise go undiagnosed have access to affordable TB tests.