Cancer care first-rate, but treatment of TB lags

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% — but still, the experience was terrifying. My little brother is 43. He has a young kid. The world needs him here. I need him here.

After four months of grueling treatment, Hank 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.

Now consider that, like Hodgkin lymphoma, tuberculosis is also generally curable. And it’s the world’s deadliest infectious disease. In 2022, TB killed 1.3 million people, 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.

TB is not easy to cure — the best standard of care requires between four and nine months of antibiotics taken daily — but neither is Hodgkin lymphoma. In fact, my brother’s cancer was vastly more expensive and complex to cure than TB is, and yet the cost of TB diagnosis and treatment is central to why the disease remains so deadly.

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. 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 succinctly explained to me: “The tests are great. If only we could afford them.”

I think of that predicament in Sierra Leone — and many other places in the world desperate for help with TB — when I reflect on how fortunate my brother was when he fell ill. Hank’s family and friends and community rallied around him. People brought food. They knitted hats that he could wear during chemo. His colleagues came together to ensure the companies he founded would thrive in his absence.

It was the hardest thing I’ve ever gone through, so I can hardly imagine what it was like for him, but when we’d talk each day, he would tell me about how the whole experience reminded him of the good humans can do and how good humans can be. I share his 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.

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 percent 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 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. He is my little brother, but I’ve long looked up to Hank and relied upon his advice.

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.

John Green is the author of several books, including The Fault in Our Stars and The Anthropocene Reviewed, and is a longtime supporter of Partners in Health. This first appeared in